Şefik Halit AKMANSU, Selmin KARATAYLI-ÖZGÜRSOY, Mustafa Mert BAŞARAN, Sinan KOCATÜRK

Adenoidektominin Orta Kulağa Etkisi: Preoperatif ve Postoperatif Timpanogram ve Otoskopik Değerlendirmenin Karşılaştırılması

Amaç: Adenoidektomi özellikle pediatrik yaş grubunda kulak burun boğaz hekimleri tarafından en sık kullanılan cerrahi yöntemlerden olup, endikasyonları genellikle ağzı açık solunum, horlama, hiponazalite, sık kulak enfeksiyonudur. Adenoid doku ile östaki tüpünün anatomik lokalizasyonunun yakınlığı nedeniyle, adenoid dokunun hipertrofisi ve enfeksiyonu; östaki tüp disfonksiyonuna, tıkanıklığa ve sonuçta orta kulak effüzyonlarına yol açabilmektedir. Biz bu retrospektif çalışmada, adenoid hipertrofisinin orta kulak basıncı üzerine etkisini; adenoidektomi öncesi ve sonrası otoskopik muayene ve timpanometrilerini karşılaştırarak değerlendirmeyi hedefledik. Gereç ve Yöntem: Çalışmamıza, adenoidektomi ve adenotonsillektomi yapılan ve kulaklarına hiçbir girişimde bulunulmayan toplam 110 hasta (220 kulak) dahil edilmiş, ve hastaların anamnezleri, nazal endoskopik muayene notları, operasyon notları ile preoperatif ve postoperatif 6. aydaki otoskopik muayene ve timpanometrik incelemeleri not edilmiştir. Bulgular: Çalışmamıza, preoperatif nazal endoskopik muayene ile koanayı en az %80 dolduran adenoid hipertrofi- ye sahip hastalar dahil edilmiştir. Preoperatif dönemde tip ve olan ve orta kulakta efüzyon işaret eden kulakların (n=63), %85,71 oranında (n:54), düzelme sağladığı görülmüştür. Dört yaşında veya daha küçük olan çocuklar ile yaşından büyük çocukların preoperatif veya postoperatif timpanogramları karşılaştırıldığında, iki grup arasında anlamlı bir fark elde edilmemiş, her iki yaş grubunun timpanogramlarında da postoperatif anlamlı düzelme kaydedilmiştir. Sonuç: Sonuç olarak, hastaların büyük oranında, sadece adenoidektomi ile, orta kulaktaki efüzyon azalabilmekte, ve ileride oluşabilecek efüzyonlu otitis media komplikasyonlarının, veya ventilasyon tüp gerekliliğin önüne geçilebilmektedir. İleride yapılacak prospektif ve kontrollü çalışmalar ile, daha güvenilir bulgular elde edilebilir.

Effects of Adenoidectomy on the Middle Ear: Comparison of Preoperative and Postoperative Tympanograms and Otoscopic Evaluations

Aim: Adenoidectomy is one of the most common surgeries performed by otolaryngologists especially in pediatric patients where the indications are generally mouth breathing, snoring, hyponasality and recurrent or persistent otitis media. Because of close localization between adenoid tissue and eustachian tube, adenoid hypertrophy and infection may cause eustachian tube disfunction, obstruction and as result middle ear effusion. In our retrospective study, we aimed to compare adenoid hypertrophy’s affect to middle ear pressure preoperatively and postoperatively by using otoscopic examination and tympanometry. Meterial And Methods: In our study 10 patients (220 ear) that underwent adenoidectomy or adenotonsillectomy without any attempt to ears were included and patients' medical histories, nasal endoscopic examinations, operation notes and preoperative and postoperative 6th month otoscopic examinations and tympanometric results were recorded. Results: Patients who had adenoid hypertrophy filling at least 80% of choana in their preoperative endoscopic examination were included in our study. Ears that were type and preoperatively(n:63), indicating middle ear effusion, were improved in 85.71% (n=54) of cases. When preoperative and postoperative tympanograms of patients older than years old and year old and/or younger patients compared, there was no significant statistical difference; and significant improvement was seen in both age groups. Conclusion: As result, in major amount of patients, with only adenoidectomy, middle ear effusions may improve, and future complications of otitis media with effusion or necessity of ventilation tubes may be prevented. More reliable findings can be gained with future prospective and controlled studies.

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