Dış Ve Orta Kulak Malformasyonlarına Yaklaşımda Klasik Ve Yeni Uygulamalar

Yıl 2018, Cilt: 40 Sayı: 1, 101 - 109, 31.01.2018

Öner Sakallıoğlu

https://doi.org/10.20515/otd.303594

Öz

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

Kaynakça

• 1. Kelley, P. E., Scholes, M. A. (2007). Microtia and congenital aural atresia. Otolaryngologic Clinics of North America, 40(1), 61-80.
• 2. Harris, J., Källén. B., Robert, E. (1996). The epidemiology of anotia and microtia. Journal Medical Genet, 33 (10), 809-813.
• 3. Phelps, P.D., Lloyd, G.A., Sheldon, P.W. (1977). Congenital deformities of the middle and external ear. The British Journal Radiol, 50(598), 714-727.
• 4. Swartz, J. D., Faerber, E. N. (1985). Congenital malformations of the external and middle ear: high-resolution CT findings of surgical import. American Journal of Neuroradiology, 6(1), 71-76.
• 5. Belucci, R. J. (1981). Congenital aural malformations: diagnosis and treatment. Otolaryngologic Clinics of North America, 14(1), 95-124.
• 6. Jafek, B.W., Nager, G.T., Strife, J., Gayler, R. W. (1975). Congenital aural atresia: an analysis of 311 cases. Transactions Section on Otolaryngol Am Acad Ophthalmol Otolaryngol, 80(6),588-595.
• 7. Harris, J., Källén, B., Robert, E. (1996). The epidemiology of anotia and microtia. Journal of Medical Genetics, 33(10), 809-813.
• 8. Ewart-Toland, A., Yankowitz, J., Winder, A., Imagire, R., Cox, V.A., Aylsworth, A. S., Golabi, M. (2000). Oculoauriculovertebral abnormalities in children of diabetic mothers. American Journal of Medical Genetics, 14; 90(4), 303-309.
• 9. Sanlaville, D., Verloes, A. CHARGE syndrome: an update (2007). European Journal of Human Genetics, 15(4), 389-399.
• 10. Jahrsdoerfer, R. A. (1978) Congenital atresia of the ear . Laryngoscope. 88(9 Pt 3 Suppl 13), 1-48.
• 11. Sando, I., Wood, R. P. 2nd. (1971). Congenital middle ear anomalies. Otolaryngol Clin North Am. 4(2), 291-318.
• 12. Patterson, M. E., Linthicum, F. H. Jr. (1970). Congenital hearing impairment. Otolaryngol Clin North Am, 3(2), 201-219.
• 13. Roberson, J.B. Jr., Goldsztein, H., Balaker, A., Schendel, S.A., Reinisch, J.F. (2013). HEAR MAPS a classification for congenital microtia/atresia based on the evaluation of 742 patients. Int J Pediatr Otorhinolaryngol, 77(9), 1551-1554.
• 14. Bartel-Friedrich, S., Wulke, C. (2007). Classification and diagnosis of ear malformations. GMS Current Topics in Otorhinolaryngol Head Neck Surg, 6, 1-21.
• 15. Aguilar, E.F. (2001). Auricular reconstruction in congenital anomalies of the ear. Facial Plastic Surgery Clinics of North America, 9(1), 159-169.
• 16. Teunissen, E. B., Cremers, W. R. J. (1993). Classification of congenital middle ear anomalies. Report on 144 ears. Annals of Otology Rhinology&Laryngology, 102(8), 606-612.
• 17. Esteves, S. D., Silva, A. P., Coutinho, M. B., Abrunhosa, J. M., Almeida e Sousa, C. (2014). Congenital defects of the middle ear--uncommon cause of pediatric hearing loss. Brazilian Journal of Otorhinolaryngol, 80(3), 251-256.
• 18. Weerda, H. (1988). Classification of congenital deformities of the auricle. Facial Plastic Surgery. 5(05), 385-388.
• 19. Beahm, E. K., Walton, R. L. (2002). Auricular reconstruction for microtia: part I. Anatomy, embryology, and clinical evaluation. Plastic and Reconstructive Surgery. 109(7), 2473-2484.
• 20. Abdel-Aziz, M. (2013). Congenital aural atresia. J Craniofac Surg. 24(4), 418-422.
• 21. Yeakley, J. W., Jahrsdoerfer, R. A. (1996). CT evaluation of congenital aural atresia: what the radiologist and surgeon need to know. Journal of Computer Assisted Tomography, 20(5), 724-731.
• 22. Jahrsdoerfer, R. A., Yeakley, J. W., Aguilar, E. A., Cole, R. R., Gray, L. C. (1992). Grading system for the selection of patients with congenital aural atresia. Otology & Neurotology, 13(1), 6-12.
• 23. Shonka, D. C. Jr, Livingston, W. J. 3rd., Kesser, B. W. (2008). The Jahrsdoerfer grading scale in surgery to repair congenital aural atresia. Archives of Otolaryngology-Head&Neck Surgery. 134(8), 873-877.
• 24. Kountakis, S. E., Helidonis, E., Jahrsdoerfer, R. A. (1995). Microtia grade as an indicator of middle ear development in aural atresia. Archives of Otolaryngology-Head&Neck Surgery. 121(8), 885-886.
• 25. de Alarcon, A., Choo, D. I. (2007). Controversies in aural atresia repair. Current Opinion Otolaryngology&Head Neck Surg, 15(5), 310-314.
• 26. Roberson Jr, J. B. (2010). Current concepts in repair of aural atresia. Current opinion in Otolaryngology & Head and Neck Surgery, 18(6), 536-538.
• 27. Sharma, A., Dorman, M. F., Spahr, A. J. (2002). A sensitive period for the development of the central auditory system in children with cochlear implants: implications for age of implantation. Ear and Hearing, 23(6), 532-539.
• 28. Roberson Jr, J. B., Reinisch, J., Colen, T. Y., Lewin, S. (2009). Atresia repair before microtia reconstruction: comparison of early with standard surgical timing. Otology & Neurotology, 30(6), 771-776.
• 29. Frenzel, H., Schönweiler, R., Hanke, F., Steffen, A., Wollenberg, B. (2012). The Lübeck flowchart for functional and aesthetic rehabilitation of aural atresia and microtia. Otology&Neurotology, 33(8), 1363-1367.
• 30. Siegert, R. (2003). Combined reconstruction of congenital auricular atresia and severe microtia. Laryngoscope, 113(11), 2021-2027.
• 31. Siegert, R., Weerda, H., Magritz, R. (2009). Basic techniques in autogenous microtia repair. Facial Plastic Surgery, 25(3), 149-157.
• 32. Glasscock, M. E., Nissen, A. J., Schwaber, M. K., Jackson, C. G. (1983). Management of congenital ear malformations. Annals of Otology, Rhinology & Laryngology, 92(5), 504-509.
• 33. El-Hoshy, Z., Abdel-Aziz, M., Shabana, M. (2008). Congenital aural atresia: transmastoid approach; an old technique with good results. Int J Pediatr Otorhinolaryngol, 72(7), 1047-1052.
• 34. Park, C., Yoo, Y. S., Hong, S. T. (2010). An update on auricular reconstruction: three major auricular malformations of microtia, prominent ear and cryptotia. Curr Opin Otolaryngol Head Neck Surg, 18(6), 544-549.
• 35. Tollefson, T. T. (2006). Advances in the treatment of microtia. Curr Opin Otolaryngol Head Neck Surg, 14(6), 412-422.
• 36. Brent, B. (1999). Technical advances in ear reconstruction with autogenous rib cartilage grafts: personal experience with 1200 cases. Plast Reconstr Surg, 104(2),319-334.
• 37. Yellon, R.F. (2009). Combined atresiaplasty and tragal reconstruction for microtia and congenital aural atresia: Thesis for the American LAryngological, Rhinological, and Otological Society. Laryngoscope, 119(2), 245-254.
• 38. Nagata, S. (1993). A new method of total reconstruction of the auricle for microtia. Plast Reconstr Surg, 92(2),187-201.
• 39. Declau, F., Cremers, C., Van de Heyning, P. (1999). Diagnosis and management strategies in congenital atresia of the external auditory canal. Study Group on Otological Malformations and Hearing Impairment. Br J Audiol, 33(5), 313-327.
• 40. Nadaraja, G.S., Gurgel, R.K., Kim, J., Chang, K. W. (2013). Hearing outcomes of atresia surgery versus osseointegrated bone conduction device in patients with congenital aural atresia: a systematic review. Otol Neurotol, 34(8), 1394-1399.
• 41. Yetişer, S. (2008). Middle ear ossicular reconstruction in congenital aural atresia and anomalies. Turkiye Klinikleri J E.N.T- Special Topics, 1(3), 31-34.
• 42. Romo, T. 3rd., Presti, P. M., Yalamanchili, H. R. (2006). Medpor alternative for microtia repair. Facial Plast Surg Clin North Am, 14(2), 129-136.
• 43. dos Santos, D. M., Goiato, M. C., Pesqueira, A. A., Bannwart, L. C., Rezende, M. C., Magro-Filho, O., Moreno, A. (2010). Prosthesis auricular with osseointegrated implants and quality of life. J Craniofac Surg, 21(1), 94-96.
• 44. Kamil, S. H., Vacanti, M.P., Vacanti, C.A., Eavey, R.D. (2004). Microtia chondrocytes as a donor source for tissue-engineered cartilage. Laryngoscop,. 114(12), 2187-2190.
• 45. Lo, J. F., Tsang, W. S., Yu, J. Y., Ho, O. Y., Ku, P. K, Tong, M. C. (2014). Contemporary hearing rehabilitation options in patients with aural atresia. , 2014, 761579.
• 46. Frenzel, H., Hanke, F., Beltrame, M., Steffen, A., Schönweiler, R., Wollenberg, B. (2009). Application of the Vibrant Soundbridge to unilateral osseous atresia cases. Laryngoscope, 119(1), 67-74.