Zusammenfassung
Neben der Eradikation pathologischer Mittelohrprozesse ist die
Wiederherstellung des destruierten Schallleitungsapparates ein Hauptziel der
modernen Ohrchirurgie. Für die partielle Rekonstruktion der Ossikelkette
sind autogene Ossikel, falls sie noch vorhanden sind, der Goldstandard. Bei
fortgeschrittener Destruktion der Gehörknöchelchenkette wird auf eine
Vielzahl alloplastischer Materialien wie Metalle, Kunststoffe, Keramiken und
Komposits als passive Implantate Rückgriff genommen. Diese
körperfremden Materialien müssen hohe Anforderungen der
Biokompatibilität, aber auch ihrer akustisch-mechanischen Eigenschaften
erfüllen. In den letzten Jahren verbreitete sich die Verwendung filigraner
Titanprothesen, welche an individuelle anatomische Vorausetzungen adaptierbar
sind. Trotz der Fortschritte in der Entwicklung passiver Implantate wird das
postoperative Hörvermögen jedoch von anderen Faktoren wie der
ungestörten Schleimhautfunktion des Mittelohres und der Tuba auditiva
entscheidend beeinflusst. Aktive Mittelohrimplantate, welche bereits mit Erfolg
bei sensorineuralen Schwerhörigkeiten eingesetzt wurden, bilden in
Fällen einer chronisch gestörten Mittelohrfunktion eine moderne
Rehabilitationsalternative. Dieser Artikel gibt einen Überblick über
den derzeitigen Stand bei der Verwendung passiver und aktiver
Mittelohrimplantate.
Abstract
Besides eradication of chronic middle ear disease, the
reconstruction of the sound conduction apparatus is a major goal of modern ear
microsurgery. The material of choice in cases of partial ossicular replacement
prosthesis is the autogenous ossicle. In the event of more extensive
destruction of the ossicular chain diverse alloplastic materials, e. g.
metals, ceramics, plastics or composits are used for total reconstruction.
Their specialised role in conducting sound energy within a half-open implant
bed sets high demands on the biocompatibility as well as the acoustic-mechanic
properties of the prosthesis. Recently, sophisticated titanium middle ear
implants allowing individual adaptation to anatomical variations are widely
used for this procedure. However, despite modern developments, hearing
restoration with passive implants often faces its limitations due to
tubal-middle-ear dysfunction. Here, implantable hearing aids, successfully used
in cases of sensorineural hearing loss, offer a promising alternative. This
article reviews the actual state of affairs of passive and active middle ear
implants.
Schlüsselwörter
Mittelohr - implantierbare Hörgeräte - Tympanoplastik - Titanprothesen
Key words
middle ear - implantable hearing aids - tympanoplasty - titanium - middle ear implants
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Priv.-Doz. Dr. med. Dirk Beutner
Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten
der Universität zu Köln
Kerpener Straße 62 50907 Köln
eMail: dirk.beutner@uni-koeln.de