KRONİK OTİTİS MEDİA CERRAHİSİNDE GREFT BAŞARISINI ETKİLEYEN FAKTÖRLER / FACTORS INFLUENCING GRAFT SUCCESS IN CHRONIC OTITIS MEDIA SURGERY

Abstract

OZET: Bu calismada, kronik otitis media sebebiyle opere edilen hastalarda, greft basarisini etkileyen faktorler arastirilmistir. Calismamizda 1999-2001 yillari arasinda opere edilmis 126 vakanin 137 kulagi prospektif olarak incelenmistir. Ortalama takip sureleri 15 ay olarak belirlenmistir. Vakalar kendi aralarinda preoperatif otoskopi ve intraoperatif bulgularina gore 5 gruba ayrilmistir. Kronik otitis media tipleri arasinda cerrahi sonuclarinda, isitme ve morfoloji acisindan basari farki bulunamamistir. Preoperatif isitme duzeyinin, postoperatif isitme kazancini etkiledigi belirlenmistir. Hastalardaki kemikcik harabiyetinin postoperatif isitmeyi olumsuz etkiledigi, kullanilan isitme rekonstruksiyonu yontemleri arasinda fark olmadigi belirlenmistir. Kullanilan cerrahi tekniklerden acik teknigin, isitme sonuclarini olumsuz etkiledigi gosterilmistir. Orta kulak mukozasinin isitme sonuclarina etkisi yoktur. Orta kulak mukozasi odemli ve islak olanlarda, greft basarisi daha dusuktur. Kulak zari perforasyonu olan vakalarda perforasyon yerinin greft basarisinda etkisi oldugu gorulmustur. Mastoidektominin ve aditus ve antrum arasindaki gecisinin greft basarisinda etkisiz oldugu belirlenmistir, Mastoidektominin secilmis vakalara uygulanmasi gerektigi dusunulmustur. Sonuc olarak, kronik otitis mediada cerrahi basariyi etkileyen pek cok faktor vardir. Bu faktorler dikkatlice incelenip, daha iyi cerrahi basariya ulasmak icin, her hastanin ozellikleri degerlendirilmelidir. ANAHTAR KELIMELER: otitis media, otit, timpanik membran perforasyonu, greftler, isitme. FACTORS INFLUENCING GRAFT SUCCESS IN CHRONIC OTITIS MEDIA SURGERY ABSTRACT: In this study, factors affecting the graft success was investigated in patients who were operated due to chronic otitis media. In this study, 137 ears of 126 patients who were operated due to chronic otitis media between 1999-2001 were evaluated prospectively. The mean follow up period was 15 months. The patiens were classified to five groups according to the preoperative otoscopic examination. The postoperative assessment of hearing level showed that there was no significant difference between groups with regard to hearing gain. The ossicular chain erosion decreased the hearing gain in all groups and there was no significant relationship between the hearing gain and ossicular reconstruction method. The patients who underwent canal wall down procedure had poor hearing level in postoperative period. Although the properties of middle ear mucosa had no effect on hearing gain. The graft take rate was lower if the middle ear mucosa was edematous and wet. The site of the tympanic membrane perforation was one of the factors influencing the graft take rate. The graft take rate was found to be independent of cortical mastoidectomy and a functional aditus ad antrum. As a conclusion, in chronic otitis media surgery there are many factors which can effect the success rate of the operation. An otologic surgeon should consider all these factors and should evaluate every patient’s features to achieve better surgical success. KEYWORDS: otitis media, otitis, tympanic membrane perforation, grafts, hearing.