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Die operative Therapie des vestibulären Schwindels

Verfahren und Indikationen

Surgical treatment of vestibular vertigo

Methods and indications

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Zusammenfassung

Vestibulärer Schwindel kann nach konservativer Therapie operativ erfolgreich behandelt werden. ZNS-Funktionsstörungen, bilaterale Vestibulopathie und reduzierte vestibuläre Kompensation sind Kontraindikationen. Entzündliche und traumatische Labyrinthfunktionsstörungen sind obligate, oft gar Notfallindikationen. Die Existenz spontaner Perilymphfisteln ist nicht belegt. Druckfehlsteuerungen wie z. B. endolymphatischer Hydrops und perilymphatische Hypertension werden durch Druckentlastungen an der Trommelfell-Gehörknöchelchen-Kette, am Saccus endolymphaticus oder am superioren Bogengang erfolgreich behandelt. Die Okklusion des posterioren Bogengangs ist bei therapieresistentem benignem paroxysmalem Lagerungsschwindel indiziert. Destruierende Therapie wie Vestibularisneurektomie oder die Kochleosakkulotomie werden im Einzelfall bei rezidivierender einseitiger Labyrinthfunktionsstörung eingesetzt. Durch Operation kann in >85% der Fälle Beschwerdefreiheit bei konservativ therapieresistentem otogenem Schwindel erreicht werden. Der Otologe verfügt im Netzwerk niedergelassener und Krankenhaus-/Klinik-Ärzte über die Verfahren zu Differenzierung, Indikationsstellung und Therapie.

Abstract

After the failure of medical treatment of dizziness or vertigo, surgical treatment is chosen according to functional diagnosis and duration and severity of symptoms. Surgery is contraindicated in patients with incomplete vestibular compensation, central nervous disorders and bilateral vestibular deficits. Surgery is obligatory in cases of sudden loss of labyrinthine function with traumatic perilymph fistula, middle ear and temporal bone processes. Endolymphatic hydrops and pathological endolymph pressure of other etiology as impaired middle ear ventilation, EVAS or superior semicircular canal dehiscence can be treated surgically. Resurfacing of dehiscence with glas ceramic implants is presented. Occlusion of the posterior semicircular canal is restricted to extremely rare conditions with non-responders to repositioning maneuvers. Ablative procedures, such as cochleosacculotomy and vestibular neurectomy are rarely indicated. More than 85% of non-responders to conservative treatment procedures in vestibular dysfunction can be improved by means of surgical procedures. Otologists have access to procedures for differentiation, indications and therapy via the network of general practitioners and hospital physicians.

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  1. Universitätsklinik für Hals-Nasen-Ohren-Heilkunde und Plastische Kopf- und Halschirurgie, Universitätsklinikum, RWTH, Pauwelsstraße 30, 52074, Aachen, Deutschland

    M. Westhofen

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Westhofen, M. Die operative Therapie des vestibulären Schwindels. HNO 56, 1003–1010 (2008). https://doi.org/10.1007/s00106-008-1807-x

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