{"id":32859,"date":"2023-09-05T11:52:01","date_gmt":"2023-09-05T11:52:01","guid":{"rendered":"https:\/\/lifelonghearing.com\/sk\/?p=32859"},"modified":"2025-04-28T14:42:50","modified_gmt":"2025-04-28T14:42:50","slug":"hluche-ucho-nie-je-mrtve-ucho","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/sk\/hluche-ucho-nie-je-mrtve-ucho\/","title":{"rendered":"Hluch\u00e9 ucho nie je m\u0155tve ucho"},"content":{"rendered":"

Hluch\u00e9 ucho nie je m\u0155tve ucho: Poh\u013ead dovn\u00fatra kochley s profesorom Helge Rask-Andersenom<\/h1><\/div>

Dnes sa s vami podel\u00edme o fascinuj\u00faci pr\u00edspevok\u00a0profesora Helgeho Raska-Andersena<\/a>, jedn\u00e9ho z popredn\u00fdch v\u00fdskumn\u00edkov v oblasti kochle\u00e1rnej anat\u00f3mie a fyziol\u00f3gie.<\/strong><\/p>\n<\/div>

<\/span><\/div><\/div><\/div><\/div><\/div>

Prof. Rask-Andersen je \u0161pecialista v oblasti ORL a audiol\u00f3gie, anat\u00f3m a elektr\u00f3nov\u00fd mikroskopista a p\u00f4sob\u00ed ako docent experiment\u00e1lnej otol\u00f3gie na Univerzite v Uppsale a v Akademickej nemocnici v Uppsale vo \u0160v\u00e9dsku. V s\u00fa\u010dasnosti vedie v\u00fdskumn\u00e9 oddelenie v akademickej nemocnici.<\/p>\n

V tomto \u010dl\u00e1nku profesor Rask-Andersen vysvet\u013euje zlo\u017eit\u00e9 funkcie slim\u00e1ka a pre\u010do by malo by\u0165 zachovanie \u0161trukt\u00fary prioritou pri ka\u017edej oper\u00e1cii kochle\u00e1rneho implant\u00e1tu \u2013 aj v pr\u00edpade \u00faplnej hluchoty. Taktie\u017e v \u010dl\u00e1nku ukazuje, pre\u010do m\u00f4\u017ee ma\u0165 po\u0161kodenie jemn\u00fdch \u0161trukt\u00far kochley tak nepriazniv\u00fd vplyv na zdravie z\u00e1kladn\u00fdch nervov\u00fdch \u0161trukt\u00far a ak\u00fd to m\u00f4\u017ee ma\u0165 vplyv na v\u00fdsledky kochle\u00e1rneho implant\u00e1tu.<\/p>\n

Po\u010fme si teda spolu pozrie\u0165 ako to vid\u00ed profesor Rask-Anderson. Text je prepis rozhovoru o, ktor\u00fd profesor poskytol na t\u00e9mu \u201ed\u00f4le\u017eitos\u0165 ochrany \u0161trukt\u00far ka\u017ed\u00e9ho slim\u00e1ka\u201c.<\/em><\/p>\n

V\u00fdznam zachovania \u0161trukt\u00fary pri kochle\u00e1rnej implant\u00e1cii<\/strong><\/h2>\n

Po\u010das \u0161t\u00fadia medic\u00edny som sa nau\u010dil elektr\u00f3nov\u00fa mikroskopiu a odvtedy sa venujem anat\u00f3mii vn\u00fatorn\u00e9ho ucha \u010dloveka. Moj\u00edm prv\u00fdm z\u00e1ujmom bola Menierova choroba a endolymfatick\u00fd vak. \u013dudsk\u00fd slim\u00e1k sk\u00famam u\u017e 30 rokov. Odkedy som so svoj\u00edm u\u010dite\u013eom, mimoriadne sk\u00fasen\u00fdm chirurgom Dr. Andersom Kinneforsom, vykon\u00e1val oper\u00e1cie b\u00e1zy lebky, hlboko som sa zauj\u00edmal o anat\u00f3miu kochley a sluchov\u00e9ho nervu. Spo\u010diatku to bolo sk\u00f4r akademick\u00e9, ale postupne s kochle\u00e1rnou implant\u00e1ciou sa to zmenilo na aplikovan\u00fa anat\u00f3miu s klinick\u00fdm zameran\u00edm.<\/p>\n

Pri mojom v\u00fdskume ma najviac zaujalo zistenie jedine\u010dnej \u0161trukt\u00fary a pozoruhodnej zachovalosti \u013eudsk\u00e9ho sluchov\u00e9ho nervu. To sa nezhodovalo s predch\u00e1dzaj\u00facimi \u0161t\u00fadiami na zvierat\u00e1ch. Zistil som, \u017ee som\u00e1 bunky \u013eudsk\u00e9ho sluchov\u00e9ho nervu s\u00fa nemyelinizovan\u00e9 (nie s\u00fa pokryt\u00e9 myel\u00ednom), \u010do mnoh\u00ed experiment\u00e1tori popierali. Nebolo to nov\u00e9 zistenie, ale spolu s molekul\u00e1rnou pr\u00e1cou sa zdalo, \u017ee to vysvet\u013euje, pre\u010do sa \u013eudsk\u00fd nerv spr\u00e1va inak a pretrv\u00e1va aj po strate vl\u00e1skov\u00fdch buniek a hluchote; skryt\u00e9 po\u017eehnanie pre nepo\u010duj\u00facich a implantovan\u00fdch.<\/p>\n

Neuverite\u013en\u00e1 zlo\u017eitos\u0165<\/strong><\/h2>\n

Vo vn\u00fatornom uchu sa nach\u00e1dzaj\u00fa riedke a nesmierne zranite\u013en\u00e9 tkanivov\u00e9 membr\u00e1ny - Reissnerova membr\u00e1na m\u00e1 hr\u00fabku len 3 mikr\u00f3ny -, ktor\u00e9 s\u00fa v\u0161ak obklopen\u00e9 najtvrd\u0161ou kos\u0165ou v tele. Preto je \u0161t\u00fadium \u013eudsk\u00e9ho slim\u00e1ka tak\u00e9 n\u00e1ro\u010dn\u00e9. Je to najn\u00e1ro\u010dnej\u0161ie tkanivo na \u0161t\u00fadium v celom tele a vysvet\u013euje, pre\u010do sa o \u0148om u \u013eud\u00ed vie tak m\u00e1lo!<\/p>\n

Riasy, \u010dasto zn\u00e1me ako vl\u00e1skov\u00e9 bunky, maj\u00fa priemer pribli\u017ene 150 - 200 nanometrov (1 nanometer = 1 mili\u00f3ntina milimetra). Mo\u017eno to porovna\u0165 s priemerom \u013eudsk\u00e9ho vlasu; ten je 30 - 100 mikrometrov (tis\u00edc nanometrov = jeden mikr\u00f3n), \u010do znamen\u00e1, \u017ee vlasov\u00e9 bunky maj\u00fa priemer men\u0161\u00ed ako 1\/100 \u013eudsk\u00e9ho vlasu.<\/p>\n

\"\"<\/p>\n

Tento obr\u00e1zok ukazuje prirodzen\u00fa kr\u00e1su \u013eudsk\u00e9ho sluchov\u00e9ho org\u00e1nu - cortiho org\u00e1nu. Zelen\u00e1 membr\u00e1na sa naz\u00fdva bazil\u00e1rna membr\u00e1na, ktor\u00e1 pom\u00e1ha filtrova\u0165 akustick\u00e9 frekvencie. Riasy vystupuj\u00fa z povrchu vn\u00fatorn\u00fdch (\u010derven\u00fdch) a vonkaj\u0161\u00edch (modr\u00fdch) vl\u00e1skov\u00fdch buniek na tekt\u00f3riov\u00fa membr\u00e1nu (lila). Nervov\u00e9 vl\u00e1kna s\u00fa \u017elt\u00e9. Tieto \u0161trukt\u00fary s\u00fa tak\u00e9 presn\u00e9, \u017ee na vyvolanie nervovej reakcie sta\u010d\u00ed pohyb rovnaj\u00faci sa priemeru at\u00f3mu vod\u00edka. Obr\u00e1zok zhotoven\u00fd v Innsbrucku v Rak\u00fasku pomocou ZEISS po\u013en\u00e9ho emisn\u00e9ho mikroskopu profesorom Raskom-Andersenom spolu s Annelies Schrott-Fischerovou, Rudolphom Glueckertom a Kristianom Pfallerom.<\/em><\/p>\n

Pri prahu sluchu strihov\u00e9 sily oh\u00fdbaj\u00fa vlasov\u00e9 bunky na menej ako nanometer - \u010do je priemer at\u00f3mu vod\u00edka. E\u0161te zauj\u00edmavej\u0161ie je, \u017ee m\u00e1me len asi 3 400 vn\u00fatorn\u00fdch vl\u00e1skov\u00fdch buniek, ktor\u00e9 s\u00fa hlavn\u00fdmi bunkami ved\u00facimi spr\u00e1vy do mozgu; porovnajte to s mili\u00f3nmi fotoreceptorov v oku. V\u0161etky va\u0161e vn\u00fatorn\u00e9 vl\u00e1skov\u00e9 bunky m\u00f4\u017eu zabera\u0165 hrot \u0161pendl\u00edka, ale s\u00fa zodpovedn\u00e9 za ka\u017ed\u00fd zvuk, ktor\u00fd po\u010dujete - pribli\u017ene 100 000 r\u00f4znych zvukov\u00fdch modal\u00edt. S tak\u00fdm mal\u00fdm po\u010dtom receptorov je ucho obzvl\u00e1\u0161\u0165 zranite\u013en\u00e9.<\/p>\n

Stria Vascularis: Elektr\u00e1re\u0148 slim\u00e1ka\u00a0\u00a0<\/strong><\/h2>\n

Na\u0161e ned\u00e1vne zistenia poskytuj\u00fa fascinuj\u00faci poh\u013ead na molekul\u00e1rnu \u0161trukt\u00faru takzvanej \"elektrickej elektr\u00e1rne\" alebo stria vascularis, ktor\u00e1 sa nach\u00e1dza v bo\u010dnej stene slim\u00e1ka. Je zodpovedn\u00e1 za produkciu energie a koncentr\u00e1ciu i\u00f3nov v endolymfe a je nevyhnutn\u00e1 pre funkciu vl\u00e1skov\u00fdch buniek.<\/p>\n

Bo\u010dn\u00e1 stena sa naz\u00fdva \"\u0161pir\u00e1lov\u00e9 v\u00e4zivo\" (ligamentum spirale). To je nespr\u00e1vne! Nie je to v\u00e4zivo ako v kolene, ale \u00fa\u017easn\u00e1 architekt\u00fara buniek, ktor\u00e1 sl\u00fa\u017ei ako elektrick\u00e1 elektr\u00e1re\u0148 alebo telef\u00f3nna bat\u00e9ria - no s drasl\u00edkov\u00fdmi i\u00f3nmi namiesto l\u00edtia. \u010eal\u0161\u00edm rozdielom je, \u017ee nepotrebuje op\u00e4tovn\u00e9 nab\u00edjanie! V\u0161etky bunky maj\u00fa r\u00f4zne funkcie a s\u00fa mimoriadne dobre z\u00e1sobovan\u00e9 arteri\u00e1lnou krvou. Je mimoriadne zranite\u013en\u00e1 a ohrozen\u00e1 pri oper\u00e1ci\u00e1ch vn\u00fatorn\u00e9ho ucha.<\/p>\n

Je pravdepodobne, \u017ee ak sa po\u0161kodia kochle\u00e1rne \u0161trukt\u00fary, tak dendrity, alebo nervov\u00e9 vl\u00e1kna sp\u00e1jaj\u00face vl\u00e1skov\u00e9 bunky s telom buniek zanikn\u00fa. Na\u0161\u0165astie sa zd\u00e1, \u017ee tento degenerat\u00edvny proces sa zastav\u00ed na \u00farovni buniek, ale pravdepodobne d\u00f4jde k ur\u010ditej ich degener\u00e1cii, prinajmen\u0161om \u010dasom. Toto po\u0161kodenie buniek vyvolan\u00e9 intoxik\u00e1ciou drasl\u00edkom m\u00e1 mal\u00fa schopnos\u0165 hojenia.<\/p>\n

\"\"<\/em><\/p>\n

Na obr\u00e1zku: Imunehistoch\u00e9mia bo\u010dnej steny \u013eudsk\u00e9ho slim\u00e1ka. Farebne s\u00fa zn\u00e1zornen\u00e9 r\u00f4zne prote\u00edny, ktor\u00e9 sa podie\u013eaj\u00fa na tvorbe elektrick\u00e9ho pr\u00fadu (zn\u00e1meho ako endokochle\u00e1rny potenci\u00e1l alebo EP) d\u00f4le\u017eit\u00e9ho pre funkciu vl\u00e1skov\u00fdch buniek. Tkanivo produkuje vysok\u00e9 koncentr\u00e1cie drasl\u00edkov\u00fdch i\u00f3nov (K+), ktor\u00e9 vyu\u017e\u00edvaj\u00fa vl\u00e1skov\u00e9 bunky. Zelen\u00e1, \u010derven\u00e1 a \u017elt\u00e1 farba predstavuj\u00fa r\u00f4zne molekul\u00e1rne usporiadania i\u00f3nov\u00fdch transport\u00e9rov. Tie sa nach\u00e1dzaj\u00fa aj v obli\u010dk\u00e1ch. Podobne ako autobat\u00e9ria s\u00fa tieto prvky obklopen\u00e9 izol\u00e1torom; tu ho tvor\u00ed bielkovina Claudin-11 (zelen\u00e1 na hornom grafickom obr\u00e1zku).<\/em><\/p>\n

Pri be\u017en\u00fdch kochleost\u00f3mi\u00e1ch sa stria vascularis v spodine \u010diasto\u010dne zni\u010d\u00ed, preto\u017ee v\u0155tanie po\u0161kod\u00ed tkaniv\u00e1 vn\u00fatorn\u00e9ho ucha. Do kochley sa dost\u00e1va kostn\u00fd prach a \u013eah\u0161ie sa rozv\u00edja z\u00e1pal a fibr\u00f3za. V s\u00fa\u010dasnosti pova\u017eujem za cenn\u00e9 pou\u017e\u00edva\u0165 techniku, pri ktorej sa zabr\u00e1ni v\u0155taniu kosti a netraumatizuje sa vn\u00fatorn\u00fd povrch kochley (endosteum). Mus\u00edm v\u0161ak prizna\u0165, \u017ee niekedy rob\u00edm aj kochleost\u00f3miu, ke\u010f je n\u00e1jdenie okr\u00fahleho okienka n\u00e1ro\u010dn\u00e9 kv\u00f4li rot\u00e1ci\u00e1m kochley. Napriek tomu si mysl\u00edm, \u017ee je d\u00f4le\u017eit\u00e9 uvedomi\u0165 si mieru traumy, ktor\u00e1 z toho vypl\u00fdva v s\u00favislosti s oper\u00e1ciou na zachovanie sluchu.<\/p>\n

\"\"<\/p>\n

Na obr\u00e1zku: N\u00e1dhern\u00e1 \"kochle\u00e1rna bat\u00e9ria\" v bo\u010dnej stene \u013eudsk\u00e9ho slim\u00e1ka. Je obklopen\u00e1 izol\u00e1torom; prote\u00ednom s n\u00e1zvom Claudin-11. Prote\u00edny konex\u00ednu s\u00fa tu hojne zast\u00fapen\u00e9 a s\u00fa dvoch typov (mutovan\u00e9 vo v\u00e4\u010d\u0161ine pr\u00edpadov vrodenej hluchoty). Pravdepodobne pom\u00e1haj\u00fa pri transporte a recirkul\u00e1cii drasl\u00edkov\u00fdch i\u00f3nov. (Liu et al. 2017)<\/em><\/p>\n

Pobyt v Scala Tympani<\/strong><\/h2>\n

Je tie\u017e d\u00f4le\u017eit\u00e9, aby elektr\u00f3dy neporu\u0161ili \u0161trukt\u00fary slim\u00e1ka, najm\u00e4 v bl\u00edzkosti prv\u00e9ho z\u00e1vitu. Ak sa elektr\u00f3da vych\u00fdli do scala vestibule, zvy\u010dajne prenikne do scala media, ktor\u00e1 obsahuje vl\u00e1skov\u00e9 bunky. Vznikne makrofistula a d\u00f4jde k \u00faniku drasl\u00edkov\u00fdch i\u00f3nov a vl\u00e1skov\u00e9 bunky prestan\u00fa pracova\u0165. I\u00f3ny drasl\u00edka unikaj\u00fa aj okolo tiel vl\u00e1skov\u00fdch buniek a nervov\u00fdch buniek, \u010do je pre ne toxick\u00e9 a v bl\u00edzkosti perfor\u00e1cie degeneruj\u00fa. Viacer\u00e9 spr\u00e1vy nazna\u010duj\u00fa, \u017ee v\u00fdsledky kochle\u00e1rneho implant\u00e1tu s\u00fa lep\u0161ie, ke\u010f sa elektr\u00f3da neodchy\u013euje do scala vestibuli.<\/p>\n

\"\"<\/p>\n

Tento obr\u00e1zok ukazuje spr\u00e1vne umiestnenie elektr\u00f3dov\u00e9ho po\u013ea kochle\u00e1rneho implant\u00e1tu v scala tympani. T\u00fato sn\u00edmku zhotovil v Innsbrucku (Rak\u00fasko) pomocou ZEISS po\u013en\u00e9ho emisn\u00e9ho mikroskopu profesor Rask-Andersen spolu s Annelies Schrott-Fischerovou, Rudolphom Glueckertom a Kristianom Pfallerom, ringoval ju Peter Bauer.<\/em><\/p>\n

Modiolus je tie\u017e zranite\u013en\u00fd a jeho povrchov\u00e1 stena (kde sa nach\u00e1dza elektr\u00f3da kochle\u00e1rneho implant\u00e1tu),ktor\u00e1 je oto\u010den\u00e1 k tel\u00e1m nervov\u00fdch buniek. Tie sa dok\u00e1\u017eu \u013eahko po\u0161kodi\u0165. Tekutina v kochlei sa tie\u017e mie\u0161a s tekutinou obklopuj\u00facou gangliov\u00e9 bunky, \u010do znamen\u00e1, \u017ee toxick\u00fd z\u00e1pal v kochlei sa roz\u0161\u00edri na nerv.<\/p>\n

Zo v\u0161etk\u00e9ho povedan\u00e9ho sa zd\u00e1 by\u0165 namieste poveda\u0165, \u017ee zachovanie \u0161trukt\u00fary pri oper\u00e1cii kochle\u00e1rnej implant\u00e1cie by malo by\u0165 prioritou u ka\u017ed\u00e9ho pacienta, aj to aj \u00faplnej hluchote.<\/p>\n

\u010eakujeme v\u00e1m, profesor Rask-Andersen, v\u00e1\u017eime si v\u00e1\u0161 zanieten\u00fd v\u00fdskum a hlbok\u00fd pr\u00ednos. <\/em><\/strong><\/p>\n

V druhej \u010dasti tohto seri\u00e1lu n\u00e1m profesor Rask-Andersen uk\u00e1\u017ee, \u010do n\u00e1m m\u00f4\u017ee pon\u00faknu\u0165 bud\u00faci v\u00fdskum v oblasti rie\u0161enia straty sluchu - vr\u00e1tane kme\u0148ov\u00fdch buniek, g\u00e9novej terapie a vyu\u017eitia prirodzen\u00fdch imunitn\u00fdch reakci\u00ed v n\u00e1\u0161 prospech.<\/em><\/strong><\/p>\n

Zistite viac o zachov\u00e1van\u00ed \u0161trukt\u00far kochley<\/strong><\/h2>\n

Ste pripraven\u00ed dozvedie\u0165 sa viac o tom, ako m\u00f4\u017ee d\u00f4js\u0165 k po\u0161kodeniu \u0161trukt\u00far vo vn\u00fatri slim\u00e1ka? Pozrite si t\u00fato u\u017eito\u010dn\u00fa pr\u00edru\u010dku o vn\u00fatrou\u0161n\u00fdch tekutin\u00e1ch a v\u00fdzname endokochle\u00e1rneho potenci\u00e1lu.<\/p>\n

Ak\u00e9 faktory ovplyv\u0148uj\u00fa v\u00fdsledky zachovania \u0161trukt\u00fary? Pre\u010d\u00edtajte si, ako m\u00f4\u017eu kon\u0161trukcia elektr\u00f3dov\u00e9ho po\u013ea a chirurgick\u00fd pr\u00edstup v\u00fdznamne ovplyvni\u0165 zachovanie \u0161trukt\u00fary a v\u00fdsledky po\u010dutia.<\/p>\n

Chcete viac tak\u00fdchto skvel\u00fdch \u010dl\u00e1nkov? Prihl\u00e1ste sa na odber a dost\u00e1vajte najnov\u0161ie \u010dl\u00e1nky priamo do svojej e-mailovej schr\u00e1nky.<\/p>\n

* Nie v\u0161etky uveden\u00e9 produkty, funkcie a indik\u00e1cie s\u00fa dostupn\u00e9 vo v\u0161etk\u00fdch oblastiach. \u010eal\u0161ie inform\u00e1cie v\u00e1m poskytne miestny z\u00e1stupca spolo\u010dnosti MED-EL.<\/p>\n

Obr\u00e1zky so s\u00fahlasom profesora Rask-Andersena a t\u00edmu. Portr\u00e9t so s\u00fahlasom Uppsalskej akademickej nemocnice<\/p>\n

Lie, W., Schrott-Fischer, A., Glueckert, R., Benav, H., & Rask-Andersen, H. (2017) \u013dudsk\u00e1 \u201ekochle\u00e1rna bat\u00e9ria\u201c \u2013 Claudin-11 Barrier and Ion Transport Proteins in the Lateral Stena Cochlea.\u00a0Predn\u00e9.\u00a0Mol.\u00a0Neurosci.\u00a010:239.<\/em><\/p>\n<\/div>

Source<\/h2>
\n

https:\/\/blog.medel.com\/userstories\/why-a-surgeon-chose-a-med-el-cochlear-implant\/<\/a><\/p>\n<\/div>

<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"

Hluch\u00e9 ucho nie je m\u0155tve ucho: Poh\u013ead dovn\u00fatra kochley s profesorom Helge Rask-Andersenom<\/p>\n","protected":false},"author":4,"featured_media":32860,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-32859","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-sk"],"yoast_head":"\nHluch\u00e9 ucho nie je m\u0155tve ucho - Slovak<\/title>\n<meta name=\"description\" content=\"Hluch\u00e9 ucho nie je m\u0155tve ucho: dnes sa s vami podel\u00edme o fascinuj\u00faci pr\u00edspevok profesora Helgeho Raska-Andersena.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/lifelonghearing.com\/sk\/hluche-ucho-nie-je-mrtve-ucho\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hluch\u00e9 ucho nie je m\u0155tve ucho - 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