Moderne Schwindeldiagnostik

 

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Zusammenfassung

„Schwindel“ ist ein vieldeutiges Syndrom, mit dem der HNO-Arzt täglich konfrontiert wird. Im Hinblick auf die komplexen Funktionen des Orientierungssinnes bezeichnet man „Schwindel“ heute als Orientierungsstörung, eine gestörte Wahrnehmung des Körpers im Raum. Neben den häufigen klassischen Schwindelsyndromen (z. B. Lagerungsschwindel, Neuritis vestibularis, Morbus Menière), bei dem „Schwindel“ das Leitsymptom darstellt, tritt „Schwindel“ als Haupt- oder Begleitsymptom bei einer Vielzahl von HNO-Erkrankungen mit Beteiligung des Innenohres auf. Das betrifft z. B. akute oder chronische virale oder bakteriell bedingte Infektionen des Ohres mit seröser oder bakterieller Labyrinthitis, verletzungsbedingten Störungen (z. B. Barotrauma, Otobasisfraktur, Labyrinthkontusion), chronisch-entzündliche Knochenprozesse sowie Innenohraffektionen im perioperativen Verlauf. Schwindeldiagnostik hat in den letzten Jahren durch neue diagnostische Möglichkeiten einen Paradigmenwechsel erfahren. In der Notfalldiagnostik lassen sich periphere und zentrale Störungen bei „Schwindel“ (akutes vestibuläres Syndrom) mit einfachen Algorithmen differenzieren. Die Einführung moderner vestibulärer Testverfahren (Videokopfimpulstest, vestibulär evozierte myogene Potenziale) in die klinische Praxis hat zu neuen Diagnosemöglichkeiten geführt. Das erlaubt erstmals eine komplexe objektive Beurteilung aller Anteile des Gleichgewichtsorgans mit relativ geringem Aufwand. Gemeinsam mit etablierten Methoden ist eine frequenzspezifische Beurteilung der Funktionen vestibulärer Reflexe möglich. Mithilfe neuer Klassifikationen lassen sich Schwindelsyndrome klinisch besser einordnen. Moderne radiologische Verfahren, wie z. B. die intratympanale Gadoliniumapplikation beim Morbus Menière mit Visualisierung eines endolymphatischen Hydrops, beeinflussen ebenfalls die bisherigen medizinischen Standards. Moderne Methoden haben wesentlich dazu beigetragen, dass sich „Schwindel“ vor allem in der HNO-Heilkunde heute besser und zügiger abklären lässt.

Abstract

Modern diagnostic methods such as video head impulse test and cervical and ocular vestibular evoked myogenic potentials allow to measure canal and otolith function quantitatively and objectively. These methods contribute to a complex assessment of the functional integrity of all 5 sensory elements of the vestibular organ for the first time. Moreover, in combination with additional vestibular tests frequency specific and time depended changes of impairments of vestibular sensors and their pathways can be assessed. Over the past few years, new test methods have been established step by step in daily clinical diagnostic of vertigo and dizziness in acute vestibular syndrome and chronic complaints. Modern tests and concepts caused a paradigm shift in vestibular diagnostic. New classifications of vestibular disorders and algorithms provide a high diagnostic certainity and reliability although evidence-based investigations of diagnostic procedures are still missing.

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