Značaj rane insercije ventilacionih cevčica kod hroničnog sekretornog otitisa kod dece sa urođenim rascepom nepca
Sažetak
Uvod/Cilj. Otitis media sa efuzijom (OME) je gotovo univerzalna pojava kod dece sa rascepom nepca sa učestalošću većom od 90%, ali se pristup rešavanju ovog problema veoma razlikuje između autora. Disfunkcija Eustahijeve tube je glavni faktor za nastajanje sekreta u srednjem uvu, što je naročito izraženo kod dece sa urođenim rascepom nepca i objašnjava dugotrajnost ovog procesa. Cilj istraživanja bio je da se utvrdi efektivnost rane insercije ventilacionih cevčica kod dece sa rascepom nepca prilikom palatoplastike, posmatrajući tok i dugotrajnost oboljenja, kao i razvoj komplikacija. Metode. U prospektivnoj studiji sa unapred određenim pravilnim intervalima i obeležjima posmatranja praćene su dve grupe dece. U prvoj grupi (E) bilo je 45 dece sa urođenim rascepom nepca kojima je urađena rana insecija ventilacionih cevčica prilikom palatoplastike, a u drugoj (K) isti broj dece sa rascepom nepca koja su po potrebi lečena konzervativnim tretmanima. Obeležja posmatranja bila su nalazi otomikroskopije, timpanometrije i tonalne liminarne audiometrije. Svako dete pojedinačno je praćeno punih pet godina na ukupno devet kontrola. Rezultati. Analiza rezultata pokazala je da ne postoje statistički značajne razlike između dve posmatrane grupe u odnosu na tok i dugotrajnost prisustva sekreta u srednjem uvu, kao ni na razvoj komplikacija i govora. Zaključak. Na osnovu rezultata koje smo dobili možemo da zaključimo da ne postoji veliki benefit u ranoj inserciji ventilacionih cevčica kod dece sa rascepom nepca, te je naša preporuka redovno praćenje deteta i konzervativna terapija po potrebi, a insercija ventilacionih cevčica onda kada hirurg na osnovu svog iskustva i individualnog nalaza ispitanika to smatra neophodnim.
Reference
Flynn T, Möller C, Jönsson R, Lohmander A The high prevalence of otitis media with effusion in children with cleft lip and pa-late as compared to children without clefts. Int J Pediatr Otorhinolaryngol 2009, 73(10):1441–6.
Alt A. Heilung der Taubstummheit Erzielte durch Beseitigung einer Otorrhoe und einer Augebornen Gaumenspalte. Arch fur Augen u. Ohrenheit 1978; 7: 211.
Sheahan P, Miller I, Sheahan JN, Earley MJ, Blayney AW. Inci-dence and outcome of middle ear disease in cleft lip and/or cleft palate. Int J Pediatr Otorhinolaryngol 2003; 67(7): 785−93.
Paradise JL, Bluestone CD. Early treatment of the universal otitis media of infants with cleft palate. Pediatrics 1974; 53(1): 48–54.
Andrews PJ, Chorbachi R, Sirimanna T, Sommerlad B, Hartley BE. Evaluation of hearing thresholds in 3-month-old children with a cleft palate: the basis for a selective policy for ventilation tube insertion at time of palate repair. Clin Otolaryngol Allied Sci 2004; 29(1): 10−7.
Grant HR, Quiney RE, Mercer DM, Lodge S. Cleft palate and glue ear. Arch Dis Child 1988; 63(2): 176−9.
Koempel JA, Kumar A. Long-term otologic status of older cleft palate patients. Indian J Pediatr 1997; 64(6): 793−800.
Skolnik EM. Otologic evaluation of cleft palate patients. La-ryngoscope 1958; 68(11): 1908−59.
Stool SE, Randall P. Unexpected ear disease in infants with cleft palate. Cleft Palate J 1967; 4: 99−103.
Muntz HR. An overview of middle ear disease in cleft palate children. Facial Plast Surg 1993; 9(3): 177−80.
Rood SR, Stool SE. Current concepts of the etiology, diagnosis and management of cleft palate related otopathologic disease. Otolaryngol Clin North Am 1981; 14(4): 865−84.
Sheahan P, Miller I, Sheahan JN, Earley MJ, Blayney AW. Inci-dence and outcome of middle ear disease in cleft lip and/or cleft palate. Int J Pediatr Otorhinolaryngol 2003; 67(7): 785−93.
Sadé J. The nasopharynx, eustachian tube and otitis media. J Laryngol Otol 1994; 108(2): 95−100.
Bluestone CD. Pathogenesis of otitis media: role of eustachian tube. Pediatr Infect Dis J 1996; 15(4): 281−91.
Paparella MM, Shea D, Meyerhoff WL, Goycoolea MV. Silent otitis media. Laryngoscope 1980; 90(7 Pt 1): 1089−98.
Tos M, Poulsen G, Borch J. Etiologic factors in secretory otitis. Arch Otolaryngol. 1979; 105(10): 582−8.
du Toit DF. Relevance of the pharyngotympanic tube. SADJ 2003; 58(8): 335−7.
Braganza RA, Kearns DB, Burton DM, Seid AB, Pransky SM. Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants. Cleft Palate Craniofac J 1991; 28(3): 305−7.
Maue-Dickson W, Dickson DR. Anatomy and physiology related to cleft palate: current research and clinical implications. Plast Reconstr Surg 1980; 65(1): 83−90.
Güneren E, Ozsoy Z, Ulay M, Eryilmaz E, Ozkul H, Geary PM. A comparison of the effects of Veau-Wardill-Kilner palatoplasty and furlow double opposing Z-plasty operations on eustachian tube function. Cleft Palate Craniofac J 2000; 37(3): 266−70.
Arnold WH, Nohadani N, Koch KH. Morphology of the auditory tube and palatal muscles in a case of bilateral cleft palate. Cleft Palate Craniofac J 2005; 42 (2): 197−201.
Bluestone CD, Beery QC, Cantekin EI, Paradise JL. Eustachian tube ventilatory function in relation to cleft palate. Ann Otol Rhinol Laryngol 1975; 84(3 Pt 1): 333−8.
Casselbrant ML, Doyle WJ, Cantekin EI, Ingraham AS. Eustachian tube function in the rhesus monkey model of cleft palate. Cleft Palate J 1985; 22(3): 185−91.
Finkelstein Y, Talmi YP, Nachmani A, Hauben DJ, Zohar Y. Levator veli palatini muscle and eustachian tube function. Plast Reconstr Surg. 1990 May;85(5):684-92; discussion 693−7.
Huang MH, Lee ST, Rajendran K. A fresh cadaveric study of the paratubal muscles: implications for eustachian tube function in cleft palate. Plast Reconstr Surg 1997; 100(4): 833−42.
Kriens OB. An anatomical approach to veloplasty. Plast Re-constr Surg 1969; 43(1): 29−41.
Matsune S, Sando I, Takahashi H. Insertion of the tensor veli palatini muscle into the eustachian tube cartilage in cleft palate cases. Ann Otol Rhinol Laryngol 1991; 100(6): 439−46.
Takasaki K, Sando I, Balaban CD, Ishijima K. Postnatal development of eustachian tube cartilage. A study of normal and cleft palate cases. Int J Pediatr Otorhinolaryngol 2000; 52(1): 31−6.
Smith TL, DiRuggiero DC, Jones KR. Recovery of eustachian tube function and hearing outcome in patients with cleft pa-late. Otolaryngol Head Neck Surg 1994; 111(4): 423−9.
Vanderas AP. Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review. Cleft Palate J 1987; 24(3): 216−25.
Doyle WJ, Cantekin EI, Bluestone CD. Eustachian tube function in cleft palate children. Ann Otol Rhinol Laryngol Suppl 1980; 89(3 Pt 2): 34−40.
Paradise JL, Bluestone CD. Early treatment of the universal otitis media of infants with cleft palate. Pediatrics 1974; 53(1): 48−54.
Bluestone CD, Klein JO. Otitis media with effusion, otolectosis and Eustachian tube dysfunction. In: Bluestone CD, Stool CE, editors. Pediatric Otolaryngology. Philadelphia: WB Saunders; 1983. p. 356−512.
Moore IJ, Moore GF, Yonkers AJ. Otitis media in the cleft palate patient. Ear Nose Throat J 1986; 65(7): 291–5.
Tuncbilek G, Ozgur F, Belgin E. Audiologic and tympanometric findings in children with cleft lip and palate. Cleft Palate Cra-niofac J 2003; 40(3): 304–9.
Robson AK, Blanshard JD, Jones K, Albery EH, Smith IM, Maw AR. A conservative approach to the management of otitis me-dia with effusion in cleft palate children. J Laryngol Otol 1992; 106(9): 788–92.