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H.E.L.P.-Apherese bei der Behandlung des Hörsturzes

Eine Anwendungsbeobachtung an 152 Patienten

Fibrinogen/LDL apheresis for treatment of sudden hearing loss

An observational study on 152 patients

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Zusammenfassung

Zu den am häufigsten diskutierten Ursachen des Hörsturzes zählen Störungen der kochleären Mikrozirkulation, wobei besonders erhöhte Cholesterin- und Fibrinogenspiegel einen negativen Effekt auf die Innenohrfunktion zu haben scheinen. Die H.E.L.P.-Apherese ist ein für die Hörsturztherapie evaluiertes Verfahren zur Senkung des Serumcholesterin- und des Plasmafibrinogenspiegels, das zu einer Verbesserung der Fließeigenschaften des Blutes und der kochleären Mikrozirkulation führt.

Wir untersuchten an 152 Hörsturzpatienten mit bereits erfolglos durchgeführter anderweitiger Hörsturztherapie die Remissionsraten nach einer einmaligen Apherese.

Zu einer Remission kam es in 11% der Fälle komplett, in 43% partiell. Bei 37% der Patienten ergab sich keine Veränderung des Gehörs, bei 2% eine Verschlechterung. Die Zahl der Remissionen nahm mit dem zeitlichen Abstand zwischen Hörsturz und Apherese ab. Die Zahl der kompletten Remissionen sank von 22% innerhalb der ersten 2 Wochen auf 14% nach mehr als 6 Wochen. Nach mehr als 42 Tagen konnten keine kompletten Remissionen mehr verzeichnet werden. Die Zahl der partiellen Remissionen sank im selben Zeitraum von 33% auf 13%.

Die Daten der vorliegenden retrospektiven Ergebnisdokumentation zeigen Folgendes: Eine Apheresebehandlung kann nach bereits erfolglos durchgeführter Hörsturztherapie in 54% der Fälle zu einer kompletten oder partiellen Remission führen, das therapeutische Fenster beträgt dabei etwa 6 Wochen.

Abstract

Disturbances of cochlear microcirculation are among the most discussed causes of sudden sensorineural hearing loss. Increased levels of cholesterol and fibrinogen seem to act as risk factors for inner ear disorders. Fibrinogen/LDL apheresis greatly reduces the concentration of plasma fibrinogen thus leading to improved cochlear blood flow. In a retrospective case series remission rates of 152 patients suffering from sudden sensorineural hearing loss and resistant to former treatment were investigated after treatment with a single apheresis. Complete remission was reported in 11% of patients, partial remission in 43%. 37% had no change of hearing threshold and 2% reported a decrease in hearing. Rates of complete remissions decreased from 22% within the first 2 weeks after onset of hearing loss to 14% after 6 weeks. In the same period of time rates of partial remissions decreased from 33% to 13%. The present study shows that apheresis achieved complete or partial remission in 54% of patients even after unsuccessful treatment with another therapy and the therapeutic window lies by approximately 6 weeks.

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Interessenkonflikt

M. Suckfüll erhält ein Beraterhonorar der Fa. B. Braun Medizintechnologie GmbH. Die B. Braun Medizintechnologie GmbH hat im Rahmen einer anderen Studie ein Beschäftigungsverhältnis von M. Canis für 2 Jahre finanziert.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde der Ludwig-Maximilians-Universität, Klinikum Großhadern, Machioninistraße 15, 81377, München, Deutschland

    M. Canis & M. Suckfuell

  2. Dres. Heigl, Hettich und Partner, Medizinisches Versorgungszentrum, Kempten – Allgäu, Deutschland

    F. Heigl & R. Hettich

  3. Medizinisches Wirtschaftsinstitut GmbH, München, Deutschland

    D. Osterkorn & K. Osterkorn

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  1. M. Canis
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  2. F. Heigl
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  3. R. Hettich
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  4. D. Osterkorn
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  5. K. Osterkorn
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  6. M. Suckfuell
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Correspondence to M. Canis.

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Canis, M., Heigl, F., Hettich, R. et al. H.E.L.P.-Apherese bei der Behandlung des Hörsturzes. HNO 56, 961–966 (2008). https://doi.org/10.1007/s00106-008-1818-7

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  • DOI: https://doi.org/10.1007/s00106-008-1818-7

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