{"id":32614,"date":"2026-04-27T08:02:39","date_gmt":"2026-04-27T08:02:39","guid":{"rendered":"https:\/\/lifelonghearing.com\/sl\/?p=32614"},"modified":"2026-04-27T08:02:39","modified_gmt":"2026-04-27T08:02:39","slug":"dober-sluh-kljub-osifikaciji","status":"publish","type":"post","link":"https:\/\/lifelonghearing.com\/sl\/dober-sluh-kljub-osifikaciji\/","title":{"rendered":"Dober sluh kljub osifikaciji"},"content":{"rendered":"

Kako pol\u017eevi vsadki in drugi slu\u0161ni vsadki pomagajo pri otosklerozi<\/h1><\/div>

Pri 10 do 15% ljudi z osteosklerozo niti slu\u0161ni aparati niti operacija stremenca ne morejo povrniti sluha. Za njih so slu\u0161ni vsadki dobra alternativa, najbolj pogosti pa so prav pol\u017eevi vsadki.<\/strong><\/p>\n

Eva Kohl in Yi Ge<\/em><\/p>\n<\/div>

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Dunajski otolog Adam Politzer je leta 1893 prvi\u010d opisal otosklerozo<\/em> kot samostojno bolezen. Obi\u010dajno se za\u010dne na prehodu med srednjim u\u0161esom in notranjim u\u0161esom, med stremencem in ovalnim okencem. Okoli kosti nastane \u017eeleju podobna kostna masa, zato se imenuje tudi otospongioza. <\/em>Ta po\u0161kodba se \u0161iri in okosteni, kar povzro\u010di otrditev struktur na tem mestu. Posledica je nara\u0161\u010dajo\u010da prevodna izguba sluha in, redkeje, senzorinevralna izguba sluha. V\u010dasih se razvije v funkcionalno ali popolno gluhost.<\/p>\n

V mnogih primerih je mogo\u010de sluh povrniti z obi\u010dajnimi slu\u0161nimi pripomo\u010dki ali s kirur\u0161ko zamenjavo stremenca s protezo. Vendar pa so ti ukrepi pri pribli\u017eno eni od sedmih do desetih prizadetih oseb neuspe\u0161ni. Za te primere obstaja \u0161e ena mo\u017enosti: aktivni slu\u0161ni vsadki.<\/p>\n

Pri ljudeh z otosklerozo prete\u010de v povpre\u010dju 16 let od za\u010detne izgube sluha do zdravni\u0161kega priporo\u010dila pol\u017eevega vsadka. To, koliko \u010dasa je bil \u010dlovek gluh, je klju\u010dnega pomena za kasnej\u0161o uspe\u0161no rehabilitacijo sluha s PV. \u010ceprav vsadek ne more zaustaviti napredovanja bolezni, ohranja funkcijo slu\u0161nega \u017eivca. V vsakem primeru lahko prizadeti pri\u010dakuje precej\u0161nje izbolj\u0161anje sluha s PV, zlasti ob zgodnji vsaditvi.<\/p>\n

\u0160irjenje, potek in u\u010dinki otoskleroze<\/h3>\n

Tipi\u010den bolnik z osteosklerozo je \u017eenska, belka, stara med 15 in 45 let. Mo\u0161ki in druge etni\u010dne skupine so manj pogosto prizadeti. Prvi simptomi se lahko pojavijo v \u010dasu hormonskih sprememb, na primer med nose\u010dnostjo, po nalezljivi bolezni, kot so o\u0161pice, ali po izpostavljenosti mo\u010dnemu hrupu. Razpravlja se tudi o genetski povezavi. Zanimivo je, da devet od desetih obolelih za otosklerozo ostane popolnoma brez simptomov kljub prekomerni rasti kosti in tkiva v lobanjski kosti okoli srednjega u\u0161esa!<\/p>\n

\u010ce se simptomi pojavijo, je prvi znak obi\u010dajno prevodna izguba sluha za nizkofrekven\u010dne zvoke, ki se nato v letih ali desetletjih nenehno poslab\u0161uje. Tipi\u010dna zna\u010dilnost je tako imenovana parakuzija Willisii, poimenovana po angle\u0161kem zdravniku Thomasu Willisu,<\/em> ko govor bolje razumemo v hrupnem okolju kot pa v mirnem. Pri do eni tretjini prizadetih se okostenitev kasneje raz\u0161iri v notranje uho, kar povzro\u010di kombinirano ali senzori\u010dno izgubo sluha. \u010ce se notranje uho (pol\u017e) posebej mo\u010dno okosti, govorimo o okostenitvi pol\u017ea.<\/p>\n

Otoskleroza obi\u010dajno prizadene obe u\u0161esi, vendar ne vedno v enaki meri. Ve\u010dina prizadetih oseb razvije tudi zvonjenje v u\u0161esih, znano kot tinitus; pribli\u017eno 40 odstotkov trpi tudi zaradi blage vrtoglavice. Pri 10 do 15 odstotkih prizadetih oseb ostanejo slu\u0161ne ko\u0161\u010dice gibljive, vendar rast tkiva proizvaja snovi, ki po\u0161kodujejo notranje uho in povzro\u010dajo senzorinevralno izgubo sluha \u2013 to imenujemo otoskleroza notranjega u\u0161esa.<\/p>\n

Implanti – pomembna alternativa v terapiji!<\/strong><\/p>\n

\"\"

Yi Ge, MD, vi\u0161ji vodja podro\u010dja medicinskih zadev pri MED-EL: “\u010ce niti slu\u0161ni aparat niti stapedektomija ne moreta povrniti sluha, lahko bolniki z otosklerozo obi\u010dajno optimalno izkoristijo razli\u010dne sisteme vsadkov.” \u00a9private<\/p><\/div>\n

Specialisti za ORL pri bolnikih z otosklerozo pogosto uporabljajo strategijo \u00bbpozornega \u010dakanja\u00ab. Obi\u010dajni slu\u0161ni aparati so zasnovani za kompenzacijo blage okvare sluha. Pri bolnikih z znatno prevodno izgubo sluha pogosto dose\u017eemo dobre rezultate s stapedektomijo<\/em> (operacijo stremenca). Stremence je ena od treh ko\u0161\u010dic srednjega u\u0161esa in je obi\u010dajno mesto, kjer se okostenitev za\u010dne. V primeru stapedektomije <\/em>ga delno ali v celoti nadomesti proteza, imenovana tudi pasivni implant za srednje uho<\/em>.<\/p>\n

Vendar pa 10 do 15 odstotkov pacientov ne dose\u017ee zadovoljivega sluha niti s slu\u0161nimi aparati, niti po operaciji, niti s kombinacijo obojega. \u00bbNa \u017ealost \u0161e vedno ni soglasja o tem, kako tak\u0161ne paciente najbolj u\u010dinkovito zdraviti,\u00ab pojasnjuje dr. Yi Ge, vi\u0161ji vodja za medicinske zadeve pri proizvajalcu implantov MED-EL. \u00bbV ve\u010dini primerov je optimalno zdravljenje z implantom.\u00ab<\/p>\n

Dejansko so med ljudmi z otosklerozo primerni kandidati za skoraj vsak sistem vsadkov. Za veliko skupino z izklju\u010dno ali prete\u017eno prevodno izgubo sluha je \u0161e posebej primeren vsadek za kostno prevodnost BONEBRIDGE. Toda ko izguba sluha v u\u0161esu izpolnjuje merila za PV, ta postane najbolj obetavna alternativa.<\/p>\n

Tudi za otosklerozo velja: pravo\u010dasna implantacija je pomembna!<\/strong><\/p>\n

Otoskleroza vklju\u010duje prekomerno rast mehkega tkiva, imenovanega fibroza<\/em>, in kosti, imenovano osteogeneza. <\/em>To je lahko izziv pri kirur\u0161kem vstavljanju elektrode PV. V tem primeru je posebej uporabno edinstveno orodje za na\u010drtovanje operacije OTOPLAN. Ta kirurgom omogo\u010da na\u010drtovanje implantacije slu\u0161nih sistemov MED-EL in celo dolo\u010ditev optimalne dol\u017eine elektrode. Velik nabor elektrod omogo\u010da natan\u010dno prilagajanje posamezni dol\u017eini \u0161e neokostenelega dela pol\u017ea, s \u010dimer se ohranijo dragocene strukture u\u0161esa, ki jih potrebujemo za razumevanje govora s PV.<\/p>\n

Otoskleroza je progresiven proces, zato se tudi posledi\u010dna slu\u0161na okvara stopnjuje. Pol\u017eevi vsadki, podobno kot slu\u0161ni aparati, operacija stremenca ali drugi slu\u0161ni vsadki, so namenjeni izbolj\u0161anju sluha in razumevanja govora. Vendar pa ne morejo upo\u010dasniti ali ustaviti prekomerne rasti kosti. Bolezen se lahko po\u010dasi razvija v ozadju in vpliva na to, kako dobro bo \u010dlovek s pripomo\u010dkom lahko sli\u0161al. Kljub temu elektri\u010dna stimulacija pomaga ohraniti funkcijo slu\u0161nega \u017eivca in prepre\u010diti nadaljnjo degeneracijo.\u00a0[1]<\/a>\u00a0[2]\u00a0<\/a>[3]<\/a><\/p>\n

Dokazano je, da ljudje z otosklerozo s pomo\u010djo pol\u017eevih vsadkov dosegajo dobre slu\u0161ne rezultate. \u00a0[4]<\/a>[5]<\/a> \u010ceprav vsadki zahtevajo obdobje privajanja in slu\u0161ne rehabilitacije, \u0161tudije ka\u017eejo, da pri pravilni indikaciji pol\u017eev vsadek pri tistem z otosklerozo vodi do znatno ve\u010djega zadovoljstva kot ga daje rekonstrukcija stremenca. [6]<\/a> Dejavniki, ki vplivajo na dober sluh s PV, se zdijo enaki kot pri drugih uporabnikih PV, ne glede na osnovno bolezen otosklerozo. Med drugim velja, da so rezultati bolj\u0161i, \u010de je obdobje, v katerem prizadeto uho ni moglo sli\u0161ati, kraj\u0161e. Zato je te\u017eko razumeti, zakaj morajo ljudje z otosklerozo \u0161e vedno \u010dakati povpre\u010dno 16 let, preden jim PV kon\u010dno povrne sluh.<\/p>\n

[1]<\/a>\u00a0Kopelovich JC, et al. Intracochlear electrical stimulation suppresses apoptotic signaling in rat spiral ganglion neurons after deafening in vivo. Otolaryngol Head Neck Surg. 2013 Nov;149(5):745-752. doi: 10.1177\/0194599813498702.
\n[2]<\/a>\u00a0Chen I, et al. The effect of cochlear-implant-mediated electrical stimulation on spiral ganglion cells in congenitally deaf white cats. J Assoc Res Otolaryngol. 2010 Dec;11(4):587-603. doi: 10.1007\/s10162-010-0234-3.
\n[3]<\/a>\u00a0Fallon JB, et al. Effects of chronic cochlear electrical stimulation after an extended period of profound deafness on primary auditory cortex organization in cats. European Journal of Neuroscience. 2014 March; 39(5):811-820. doi: 10.1111\/ejn.12445
\n[4]<\/a>\u00a0Skarzynski PH, et al. Outcomes of Cochlear Implantation in Patients with Far-Advanced Otosclerosis Who Had Previously Undergone Stapes Surgery. J Int Adv Otol. 2024;20(2):101-107. doi:10.5152\/iao.2024.231332
\n[5]<\/a>\u00a0Assiri M, et al. Cochlear implantation among patients with otosclerosis: a systematic review of clinical characteristics and outcomes.\u00a0Eur Arch Otorhinolaryngol<\/em>. 2022;279(7):3327-3339. doi:10.1007\/s00405-021-07036-5
\n[6]<\/a>\u00a0Kondo M, et al. Cochlear Implantation in Far Advanced Otosclerosis: A Systematic Review and Meta-Analysis.\u00a0Laryngoscope<\/em>. 2023;133(6):1288-1296. doi:10.1002\/lary.30386<\/p>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"

Pri 10 do 15% ljudi z osteosklerozo niti slu\u0161ni aparati niti operacija stremenca ne morejo povrniti sluha. Za njih so slu\u0161ni vsadki dobra alternativa, najbolj pogosti pa so prav pol\u017eevi vsadki.<\/p>\n","protected":false},"author":10,"featured_media":32645,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[518],"tags":[],"class_list":["post-32614","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravje"],"yoast_head":"\nDober sluh kljub osifikaciji - Slovenia<\/title>\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\/sl\/dober-sluh-kljub-osifikaciji\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dober sluh kljub osifikaciji - Slovenia\" \/>\n<meta property=\"og:description\" content=\"Pri 10 do 15% ljudi z osteosklerozo niti slu\u0161ni aparati niti operacija stremenca ne morejo povrniti sluha. 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