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Indikation und Erfolge der operativen Therapie des vestibulären Schwindels

Indications for operative therapy of vestibular vertigo and the associated success rates

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Zusammenfassung

Operationen gegen Labyrinthschwindel mit schwerer Beeinträchtigung ohne Ansprechen auf Medikamente werden uneinheitlich indiziert. Therapieergebnisse sind wegen unterschiedlicher Ziel- und Erfolgsparameter nur bedingt vergleichbar. Eine Übersicht über Schrifttum und eigenes Vorgehen gibt Hinweise für Indikation und Gefahren in der operativen Therapie vestibulären Schwindels. Ergebnisse funktionserhaltender und ablativer Therapie werden vergleichend bewertet. Eine Operationsindikation bei Menière-Syndrom (nichtidiopathisch) durch Paukenröhrchen besteht bei mittelohrvermittelter Druckeinwirkung, bei M. Menière (idiopathisch) für Frühformen mit erhaltener Hör- und Labyrinthfunktion durch die endolymphatische Shunt-Operation, bei deren Versagen durch Vestibularisneurektomie zum Hörerhalt und durch Cochleosacculotomie bei erloschenem Hörvermögen. Seltene Indikationen ergeben sich bei therapieresistentem benignem paroxysmalem Lagerungsschwindel und Dehiszenz des superioren Bogengangs. Erfolge der funktionserhaltenden Verfahren bei Menière-Syndrom und M. Menière liegen zwischen 70 und 88 %, der ausschaltenden Verfahren bei > 90 %, bei Bogengangsokklusionen von > 95 %.

Abstract

The indications for surgical treatment of labyrinthine vertigo associated with severe impairment and a lack of response to medication are heterogeneous. Due to different therapeutic goals and success parameters, the results of treatments can only be compared to a limited extent. This overview of the current literature and procedures performed by the author contains recommendations for indications and outlines the risks associated with operative therapy of vestibular vertigo. Results of function-preserving and ablative therapies are compared. Surgical treatment of Menière’s syndrome (non-idiopathic) using tympanostomy tubes is indicated in cases of increased middle ear pressure; Meniere’s disease (idiopathic) in its early stages can be treated with the endolymphatic shunt operation to preserve hearing and balance functions and where these techniques fail, with vestibular neurectomy for preservation of hearing or with cochleosacculotomy in the case of deafness. Rare indications are intractable benign paroxysmal positional vertigo and superior semicircular canal dehiscence syndrome (SCDS). The function preservation success rate in cases of Meniere’s syndrome and disease is 70–88 %, ablative procedures are effective in > 90 % of cases and occlusion of the superior or posterior canals is successful in > 95 % of patients.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Westhofen gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Hals-Nasen-Ohren-Heilkunde und Plastische Kopf- und Halschirurgie, Universitätsklinikum Aachen, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Deutschland

    M. Westhofen

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Westhofen, M. Indikation und Erfolge der operativen Therapie des vestibulären Schwindels. HNO 61, 752–761 (2013). https://doi.org/10.1007/s00106-013-2749-5

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