Dış Ve Orta Kulak Malformasyonlarına Yaklaşımda Klasik Ve Yeni Uygulamalar

Dış kulağın anormal embriyolojik gelişimi aurikulada deformiteyle sonuçlanır. Aurikula deformitesi olanlarda sıklıkla dış kulak kanalı, orta kulak, fasiyal sinir ve düşük olasılıkta olsa iç kulakta da deformite olması beklenmelidir. Kulak anomalileri sınıflaması ile ilgili tartışmalar halen süregelmektedir. Tüm sınıflama sistemlerinde tip I normal ve ya normale yakın aurikulaya karşılık gelmektedir. Daha ileri tiplerde deformitenin şiddeti artmaktadır. Tip III/IV ise ‘yerfıstığı’ görünümlü kulak ya da kulak yokluğunu (anoti) ifade eder. Öte yandan bir konjenital aural atrezi olgusunda aurikula eğer normalse orta kulak ve iç kulak yapılarının normal olma olasılığı yüksektir. Tedavide bilateral aural atrezi olgularında yapılacaklar oldukça bellidir. Erken dönemde kemik iletimli işitme cihazları uygulanır. Unilateral olgulardaysa erken dönemde cerrahi müdahale, sadece gerekli durumlarda (kolesteatoma, fasiyal sinir paralizisi gibi) yapılır. Diğer unilateral olgularda hasta ve ailesi karar verene dek erişkin çağa kadar beklenebilmektedir. Mikroti onarımının belki de en önemli endikasyonu anormal görüntünün neden olduğu psikolojik sonuçlardır. Tatminkar görünümün yanısıra gözlük ve işitme cihazı kullanılmasına uygun aurikula elde edilmelidir. Atrezili hastalarda işitme de bozulmuştur. Estetik rehabilitasyonun yanı sıra işitmeyi düzeltmeye yönelik timpanoplasti prosedürleri de yapılmalıdır. Bu nedenle hastaların tedavi seçenekleri bakımından yaşamın erken döneminde uygun olarak değerlendirilmesi önemlidir. Aurikula rekonstrüksiyonu ve işitme rehabilitasyonu seçenekleri unilateral ve bilateral olgularda hastanın durumu da gözönüne alınmak suretiyle titizlikle ele alınmalıdır.

Anahtar Kelimeler:

Mikroti, Konjenital aural atrezi, Aurikula rekonstrüksiyonu

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