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HNO

, Volume 65, Issue 9, pp 724–734 | Cite as

Rehabilitation bei Fazialisparese und Schwindel bei Patienten mit Vestibularisschwannom

Leitthema

Zusammenfassung

Hintergrund

Fazialisparese und Schwindel als Symptom eines Vestibularisschwannoms (VS) oder als Folge der Therapie beeinträchtigen die Lebensqualität der Patienten erheblich.

Fragestellung

Die Arbeit analysierte die aktuelle Literatur zum Thema und gibt darauf basierend Handlungsempfehlungen.

Material und Methode

Es handelt sich um eine PubMed-basierte Literaturrecherche der letzten 10 Jahre.

Ergebnisse

Zur Behandlung der akuten postoperativen Fazialisparese nach VS-Operation gibt es keine evidenzbasierte medikamentöse Therapie. Für die chirurgische Therapie gibt es etablierte Verfahren zur Nervenrekonstruktion, zum Muskeltransfer und zu statischen Maßnahmen. Eine physiotherapeutische Bewegungstherapie, am besten mit Biofeedback, verbessert möglicherweise die Fazialisfunktion bei Patienten mit Defektheilung. Botulinumtoxin ist Therapie der Wahl zur Behandlung von Synkinesien. Gegen akuten und chronischen Schwindel bei Patienten mit VS werden dieselben Antivertiginosa wie bei anderen Schwindelpatienten eingesetzt. Bei noch erhaltener Vestibularisfunktion ist die präoperative intratympanale Gentamycinausschaltung und ein Kompensationstraining eine vielversprechende Therapiestrategie, um postoperativen Schwindel zu verringern. Eine gute Vestibularisrehabilitation umfasst ein intensives und regelmäßiges Bewegungstraining, am besten mit Echtzeitfeedback und Therapiekontrolle.

Schlussfolgerungen

Es gibt eine Vielzahl durch Studien belegte konservative, chirurgische oder kombiniert konservativ-chirurgische Behandlungsoptionen zur individuellen Fazialisrehabilitation bei VS-Patienten. Bei akutem Schwindel ist eine Pharmakotherapie angezeigt. Sowohl bei akutem als auch bei belastendem chronischem Schwindel lindert eine intensive Bewegungstherapie die Beschwerden.

Schlüsselwörter

Akustikusneurinom N. facialis N. vestibulocochlearis Gleichgewicht Lebensqualität Synkinesie 

Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma

Abstract

Background

Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients’ quality of life.

Objective

This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo.

Methods

The present review describes a PubMed-based search of the literature of the past 10 years.

Results

There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control.

Conclusion

There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.

Keywords

Acoustic neuroma Facial nerve Vestibulocochlear nerve Postural balance Quality of life Synkinesis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

B. Müller, G. Volk und O. Guntinas-Lichius geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Hals-, Nasen-, OhrenheilkundeUniversitätsklinikum JenaJenaDeutschland

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