Die toxische Innenohrläsion bei viraler Otitis media mit subakuter Mastoiditis: eine retrospektive Studie zur Therapie und zu CT-morphologischen Merkmalen
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Philipps-Universität Marburg
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Abstract
An acute otitis media can occur because of a viral infection of the upper respiratory
tract. A known complication of middle ear inflammation is toxic inner ear damage,
where toxic substances from the middle ear effusion enter the labyrinth, causing
sensorineural hearing loss. Toxic inner ear damage is more likely to occur in cases
of viral otitis media. The round window membrane is predominantly described in
the literature as the passage region for a variety of toxic substances. Additionally,
there have been discussions about osseous diffusion through weak points in the bony
labyrinth, supported by histological studies showing pronounced canal-like structures in the innerear bony structure. Other studies have identified the Fissula
ante fenestram as a semi- permeable connection between the middle ear and inner
ear. Previous research has also provided initial evidence of a relationship between
reduced bone density and the occurrence of toxic inner ear damage.
There is currently no specific treatment regimen for acute otitis media with toxic
inner ear damage. Despite the prevailing conservative therapy, there are publications
in the literature reporting successful surgical treatments. This study compares three
conservative therapy regimens and compares conservative therapy with surgical therapy.
To gain further insights into anatomical features in this patient population, CT
datasets were obtained and examined for differences in bone structure and other
anatomical characteristics.
Regarding the three conservative therapy regimens, the analysis of individual frequencies revealed only minor differences. Specifically, when comparing the averaged
difference values, which should be used as parameters for overall hearing recovery,
no statistically significant differences were observed. Nevertheless, all conservative
therapy groups showed a significant improvement in inner ear function.In the comparison of surgical and conservative therapy, statistical differences in the
course of treatment were identified. In this patient population, surgical treatment
was considered a salvage therapy in cases of stagnant hearing recovery in the clinical
course. The statistical analysis showed that both groups were initially comparable
at the start of treatment. However, the patients later classified in the surgical group
experienced a significant decline over time, leading to the decision for mastoidectomy. Subsequently, this group exhibited a significant recovery of hearing ability.
As a result, patients in both the conservative and surgical therapy arms achieved
comparable results.
When comparing the affected petrous bones with those of healthy ear controls, several anatomical abnormalities were identified. The petrous bones with toxic inner
ear damage showed significantly reduced pneumatisation. Furthermore, significantly
narrower anatomical conditions in the Aditus ad antrum of the affected individuals
were observed. A statistically confirmed thinning of bone was found in the course
of the lateral semicircular canal. The analysis of Hounsfield units on the labyrinth
block revealed significantly lower values at the Fissula ante fenestram and the precochlea, which aligns with the previous assumptions about weak points in this area.
This study demonstrated that patients who fail to respond to conservative therapy
could experience significant hearing recovery through surgical treatment. However,
no significant advantages were found among the investigated conservative therapy
regimens. Further research is needed to establish a potential new standard for the
treatment of this patient population. The findings of this study regarding the microstructures of the petrous bone in patients with toxic inner ear damage should also
prompt further investigations. The role of the canal system, consisting of chondroosseous and Volkmann canals, in the bony labyrinth remains unclear to this day.
Speculations have also been made about the specific function of the Fissula ante
fenestram. Connections with other ear diseases, such as otosclerosis, remain part of
the current discussion.
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Dates
Created: 2023Issued: 2025-03-13Updated: 2025-03-13
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
viral otitis mediahearing lossotitisinner earmastoiditis
DFG-subjects
InnenohrläsionHörminderungInnenohrOtitis mediaMastoiditsvirale Otitis
DDC-Numbers
610
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Fahr, Lukas: Die toxische Innenohrläsion bei viraler Otitis media mit subakuter Mastoiditis: eine retrospektive Studie zur Therapie und zu CT-morphologischen Merkmalen. : Philipps-Universität Marburg 2025-03-13. DOI: https://doi.org/10.17192/z2024.0306.