Tamer ERDEM, Orhan ÖZTURAN, Murat Cem MİMAN, Murat UĞRAŞ

Lazer yardımlı östaki tuboplastisi: Olgu sunumu

Östaki tüpü disfonksiyonlarının cerrahi olarak tamiri ol- dukça zordur. Östaki disfonksiyonuna bağlı timpanik membran ve ortakulak komplikasyonlarını ventilasyon tüpü uygulaması ile çözmek her zaman mümkün ola- mamakta ve sıklıkla çok sayıda uygulama gerekmek- tedir. Bu yazıda, daha önce östaki tüpü disfonksiyonu- na bağlı olarak gelişen ve 18 kez ventilasyon tüpü uy- gulaması gerektiren kronik, tekrarlayıcı effüzyonlu oti- tis mediası olan 47 yaşında erkek hasta sunuldu. Has- taya genel anestezi altında ve endoskopi eşliğinde, her iki kulak için lazer yardımlı östaki tuboplastisi uygu- landı. Tuba östakinin nazofarenjeal ağzı posterior yas- tığındaki mukoza, altmukoza ve kısmen de kartilajinöz doku Nd-YAG ve Holmium lazerle ablate edildi. Hasta- nın sağ kulağında ameliyat öncesinde 37 dB olan ha- vayolu eşiği ameliyat sonrasında 22 dB’ye düştü; tip B olan timpanogram eğrisi ise tip C-1 haline geldi. Sol kulakta ise ameliyat öncesinde tip B olan timpanogram eğrisi ameliyat sonrasında tip C-2 bulundu; havayolu eşiği de 38 dB’den 33 dB’ye düştü. Sol kulakta elde edilen sınırlı iyileşme, östaki tüpü posterior yastığında- ki yetersiz ablasyona bağlandı. Ameliyattan sonra 12. ayda hastanın komplikasyonsuz olduğu görüldü

Anahtar Kelimeler:

Endoskopi, östaki tüpü/cerrahi, lazercerrahisi/yöntem, orta kulak ventilasyonu, efüzyonlu otitismedia, otolojik cerrahi prosedürler/yöntem

Laser assisted eustachian tuboplasty: a case report

Surgical treatment of eustachian tube dysfunction is stili challenging. Placement of a transtympanic ventilation tube may not be successful and may require multiple applications. We presented a 47-year-old male patient with chronic recurrent otitis media with effusion and retraction due to eustachian tube dysfunction, in whom the number of previous transtympanic tube insertions amounted to 18. He undervvent laser assist ed eustachian tuboplasty in both ears with endoscopic guidance under general anesthesia. The mucosal, submucosal, and partially the cartilaginous tissues in the posterior pillow of the nasopharyngeal orifice of the eustachian tube were ablated by Nd:YAG and holmi um :YAG laser. Following surgery, air conduction thresholds decreased from 37 dB to 22 dB, and from 38 dB to 33 dB for the right and left ears, respectively.The preoperative tympanogram curve, which was of type B for both ears was found as type C-1 on the right side, and type C-2 on left. Limited improvement seen in the left ear was ascribed to insufficient ablation of the posterior pillow of the eustachian tube. No complications were encountered within a follow-up of 12 months.

Keywords:

Endoscopy, eustachian tube/surgery, laser surgery/methods, middle ear ventilation, otitis media with effusion, otologic surgical procedures/methods,

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