Kortikale Plastizität nach Hörverlust und Cochlea-Implantation

Zusammenfassung

Das Gehirn bleibt über die gesamte Lebensspanne flexibel. Die Eigenschaft des Zentralnervensystems, sich an verändernde Anforderungen anzupassen, wird auch als neuronale Plastizität bezeichnet. Bei Personen mit einer hochgradigen oder an Taubheit grenzenden Schwerhörigkeit ist die neuronale Plastizität eine wesentliche Voraussetzung für die Hörrehabilitation mit einem Cochlea-Implantat (CI). Nach der Implantation sind Adaptationsleistungen des Zentralnervensystems notwendig, um die neuen, elektrischen Signale eines CIs zu verstehen. Obwohl viele CI-Träger ein gutes Sprachverständnis entwickeln, zeigt sich eine große Variabilität im CI-Anpassungserfolg. Es gibt deutliche Hinweise, dass intermodale Plastizität, insbesondere die Hinzuziehung des auditorischen Kortex für die Verarbeitung von visuellen Informationen, wesentlich zu dieser Variabilität beiträgt. Dieser Artikel gibt einen aktuellen Überblick über die kortikalen Veränderungen bei CI-Patienten. Dabei werden erfahrungsbedingte neuronale Veränderungen vor der Implantation (sensorische Deprivation) und danach (elektrisches Hören mit CI) vorgestellt und anhand relevanter Studienergebnisse aufgezeigt, dass die Auswirkungen von Plastizität im Hinblick auf die Restitution der Hörfunktion nicht nur adaptiv, sondern auch maladaptiv sein können. Ob die maladaptive Plastizität bei CI-Trägern durch therapeutische Strategien gezielt beeinflusst werden kann, ist bislang unklar. Um die Therapiemöglichkeiten bei CI-Trägern weiter zu optimieren, sind zukünftige Studien notwendig. Ein besseres Verständnis von adaptiver und maladaptiver Plastizität erlaubt es langfristig, therapeutische Strategien zu entwickeln, welche die kortikale Plastizität gezielt beeinflussen und so zu einer Optimierung des CI-Anpassungserfolgs beitragen.

Abstract

A fundamental characteristic of the human brain is its ability to be flexible throughout the entire lifespan. This ability for experience-related changes is referred to as neuronal plasticity and allows the brain to adequately adapt in response to the changing environment. Rehabilitation of hearing with a cochlear implant (CI) would not be possible without the capacity of the central nervous system to change as a result of experience. CIs can partly restore hearing in individuals suffering from profound hearing loss. However, electrical hearing with a CI is highly unnatural and impoverished, and cortical adaptation is required to interpret the CI input as meaningful sounds. Although many CI users develop good speech intelligibility, speech performance outcomes remain highly variable in CI users. There is first evidence for cross-modal plasticity to be one factor contributing to this variability, in particular the reorganization of the auditory cortex by the visual modality. This review provides an overview of the literature on cortical changes in CI users, considering experience-dependent neuronal changes before (sensory deprivation) and after (electrical hearing) cochlear implantation. In sum, the results of previous studies suggest that plasticity can have both adaptive and maladaptive effects on the restoration of hearing. Whether the maladaptive plasticity can be addressed by targeted rehabilitation strategies is still not clear. Additional research is needed in order to further optimize auditory rehabilitation in CI users. In the long-term, a better understanding of adaptive and maladaptive plasticity allows the development of effective clinical therapies that can exert a targeted influence on cortical plasticity. This contributes to the long-term goal of a more complete restoration of hearing with a CI.

Schlüsselwörter

neuronale Plastizität - intramodale und intermodale Plastizität - adaptive und maladaptive Plastizität - Cochlea-Implantat - auditorischer Kortex

Key words

neural plasticity - cross-modal and intra-modal plasticity - adaptive and maladaptive plasticity - cochlear implant - auditory cortex

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