Zusammenfassung
Das Hauptziel der Diagnostik vor Cochleaimplantat(CI)-Versorgung ist es, die vorliegende Hörstörung umfassend und multidisziplinär zu erfassen, um anschließend so früh wie möglich mit der Therapie zu beginnen. Die (päd)audiologische Untersuchung umfasst dabei eine Kombination subjektiver und objektiver Methoden nach dem „Puzzle-Prinzip“. In der postoperativen Verlaufsdiagnostik können mit objektiven Untersuchungsmethoden wertvolle Informationen über die Verarbeitung der angebotenen Reize im auditorischen System gewonnen werden. Insbesondere bei Säuglingen und Kleinkindern sowie nichtkooperativen Patienten kann auf Basis der Ergebnisse die Sprachprozessoranpassung optimiert, der Hörgewinn beurteilt und ggf. die Therapiestrategie angepasst werden. Frühe auditorische Potenziale (FAEP) sind die am häufigsten genutzte Methode zur Abschätzung der Hörschwelle sowie zur Beurteilung von Reifung und Integrität der Hörbahn bis zur unteren Hirnstammebene. Dabei ermöglicht die Verwendung bandbegrenzter Stimuli eine frequenzspezifische Bestimmung der Reizantwortschwelle, die Analyse der stationären „auditory steady state responses“ (ASSR) bieten darüber hinaus die Vorteile einer objektiven automatisierten Detektion. Elektrocochleographie (ECochG) und elektrisch evozierte Hirnstammpotenziale (E-FAEP) sind wichtige Informationsquellen für spezielle Fragestellungen. Die kortikalen auditorisch evozierten Potenziale nach Stimulation mit Sprachreizen oder Ton-Bursts scheinen eine vielversprechende Methode zu sein; aufgrund der hohen Variabilität der Potenziale ist ihre klinische Anwendung jedoch derzeit noch beschränkt. Die Kombination subjektiver und objektiver audiologischer Methoden führt zu einer signifikanten Zunahme der Genauigkeit der präoperativen Diagnosestellung und der postoperativen Verlaufsdiagnostik.
Abstract
The primary diagnostic aim prior to cochlear implantation is establishment of a comprehensive and multidisciplinary diagnosis, in order to subsequently begin therapy as early as possible. Audiological evaluation prior to implantation employs a test battery-approach, including subjective and objective procedures. Objective measures show high reliability and therefore play a major role in the diagnosis of difficult-to-test subjects such as infants and young children. During postoperative follow-up, objective measures offer a valid method for analyzing the effects of different stimuli on the auditory system. Particularly in infants, children, and uncooperative patients, the results of these tests enable the speech processor settings to be optimized, the hearing benefit to be assessed, and treatment to be adapted accordingly. Auditory brainstem responses (ABR) offer an excellent test/retest and inter-/intrarater reliability and validity, and are the most commonly used method for objective hearing threshold estimation and evaluation of the functional integrity of the lower auditory pathway. The use of narrow-band stimuli allows frequency-specific threshold estimation; analysis of stationary auditory steady state potentials (ASSR) adds the advantages of automated objective detection. Electrocochleography and electrically evoked ABR give valuable information in special cases. The use of cortical potentials (CAEP) in response to speech stimuli is quite promising, although the high response variability currently limits this method’s clinical application. An audiological test-battery approach combining the results of subjective and objective measures leads to significantly increased reliability of preoperative diagnosis and postoperative follow-up in cochlear implantees.
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W. Shehata-Dieler und W. Großmann geben an, dass kein Interessenkonflikt besteht.
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Shehata-Dieler, W., Großmann, W. Präoperative audiologische Evaluation und postoperative Verlaufsdiagnostik bei Cochleaimplantatversorgung. HNO 65, 298–307 (2017). https://doi.org/10.1007/s00106-016-0214-y
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DOI: https://doi.org/10.1007/s00106-016-0214-y
Schlüsselwörter
- Cochleaimplantat
- Auditorisch evozierte Potenziale
- Mikrofonpotenziale
- Elektrisch evozierte auditorische Hirnstammpotenziale
- Hörbahn