{"id":552,"date":"2012-07-15T11:12:17","date_gmt":"2012-07-15T08:12:17","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=552"},"modified":"2012-07-15T11:12:17","modified_gmt":"2012-07-15T08:12:17","slug":"barosinuzit-patofizyoloji-onlenmesi-tedavisi","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=552","title":{"rendered":"Barosin\u00fczit: Patofizyoloji, \u00f6nlenmesi, tedavisi"},"content":{"rendered":"
\n
\"\"<\/a>Sin\u00fcs barotravmas\u0131 Boyle Yasas\u0131 ile a\u00e7\u0131klanabilir. Bu yasaya g\u00f6re sabit s\u0131cakl\u0131kta herhangi bir kuru gaz\u0131n hacmi \u00e7evre bas\u0131nc\u0131 ile ters orant\u0131l\u0131 olarak de\u011fi\u015fir (V=C\/P). Bu yasaya g\u00f6re elastik bir balon i\u00e7indeki gaz, etraf\u0131ndaki bas\u0131n\u00e7 azal\u0131rsa geni\u015fleyecektir, ayn\u0131 u\u00e7u\u015f s\u0131ras\u0131nda y\u00fckselirken oldu\u011fu gibi. Havan\u0131n geni\u015flemesi, (sin\u00fcsler i\u00e7inde oldu\u011fu gibi) nemli gazlarda daha \u00e7abuk olacakt\u0131r.<\/div>\n

Sin\u00fcs barotravmas\u0131 u\u00e7u\u015fta al\u00e7alma veya y\u00fckselme periyodlar\u0131nda ger\u00e7ekle\u015febilir. Al\u00e7alma barotravmas\u0131 (s\u0131k\u0131\u015fma), y\u00fckselme barotravmas\u0131ndan (ters s\u0131k\u0131\u015fma) 2 kat daha s\u0131k g\u00f6r\u00fclse de, y\u00fckselme barotravmas\u0131 daha ciddi sa\u011fl\u0131k problemleri yarat\u0131r. S\u0131k\u0131\u015fma burun i\u00e7indeki patolojilerin yaratt\u0131\u011f\u0131 k\u00fcreli valf etkisi sonucu geli\u015fir. Y\u00fckselme s\u0131ras\u0131nda atmosfer bas\u0131nc\u0131 azal\u0131r, sin\u00fcs i\u00e7indeki hava geni\u015fler ve sin\u00fcs a\u011fz\u0131ndan d\u0131\u015far\u0131ya ka\u00e7ar. Al\u00e7alma s\u0131ras\u0131nda sin\u00fcs a\u011fz\u0131 k\u00fcre valf etkisi ile t\u0131kan\u0131r ve i\u00e7eriye daha fazla havan\u0131n girmesini engeller. Bunun sonucunda sin\u00fcs i\u00e7inde negatif bas\u0131n\u00e7 olu\u015fur. S\u0131k\u0131\u015fma s\u0131ras\u0131nda sin\u00fcs i\u00e7erisinde geli\u015fen negatif bas\u0131nca ba\u011fl\u0131 olarak a\u011fr\u0131, m\u00fckozal \u00f6dem ve ciddi vakalarda m\u00fckozal ayr\u0131lma ve kanamalar ortaya \u00e7\u0131kar. S\u0131k\u0131\u015fman\u0131n olu\u015fmas\u0131 i\u00e7in risk fakt\u00f6rleri sin\u00fcs a\u011fz\u0131n\u0131 \u00e7evreleyen m\u00fckozada \u00f6dem, iltihap, yo\u011fun s\u00fcm\u00fck, sin\u00fcs d\u0131\u015f\u0131nda polipler ve t\u00fcm\u00f6rlerdir. Burun e\u011frilikleri ve konka b\u00fclloza gibi patolojiler m\u00fckozal \u00f6dem ile birle\u015fince t\u0131kan\u0131kl\u0131\u011f\u0131 art\u0131rabilir. Ters s\u0131k\u0131\u015fma, s\u0131k\u0131\u015fmaya sebep olan patolojiler y\u00fcz\u00fcnden olabilece\u011fi gibi, maske ile bas\u0131n\u00e7l\u0131 havaland\u0131rma gibi sin\u00fcslere hava g\u00f6nderildi\u011fi durumlarda da ortaya \u00e7\u0131kabilir. Ters s\u0131k\u0131\u015fma genelde sin\u00fcs i\u00e7i patolojiler sonucu ortaya \u00e7\u0131kar; ancak t\u00fcm\u00f6rler, kafa kaidesindeki kemik devams\u0131zl\u0131klar\u0131 da nedenler aras\u0131ndad\u0131r. Y\u00fckselme s\u0131ras\u0131nda sin\u00fcs i\u00e7indeki patolojiler k\u00fcre valf etkisi ile sin\u00fcs a\u011fz\u0131n\u0131 t\u0131kayarak havan\u0131n d\u0131\u015far\u0131ya \u00e7\u0131k\u0131\u015f\u0131n\u0131 engeller. Bas\u0131n\u00e7l\u0131 hava, buldu\u011fu en zay\u0131f yerden (fizyolojik olmayan yollarla) d\u0131\u015far\u0131ya \u00e7\u0131karak subkutan veya orbital amfizem, k\u00f6rl\u00fck, beyinde hava, menenjit gibi ciddi rahats\u0131zl\u0131klara sebep olacakt\u0131r.<\/p>\n

Klinik Sunum:
\n<\/strong>Sivil havac\u0131l\u0131kta ciddi sin\u00fcs barotravmas\u0131na s\u0131k rastlanmaz, ama hafif vakalar g\u00f6r\u00fclebilir. En s\u0131k frontal sin\u00fcs (%70-80), takiben maksiller sin\u00fcs (%19-29) etkilenir. Yakla\u015f\u0131k %10 oran\u0131nda her ikisinin de etkilendi\u011fi vakalar vard\u0131r. Etmoid ve sfenoid sin\u00fcsler nadiren etkilenir.<\/div>\n
Paranazal sin\u00fcslerin barotravmadan etkilenme oranlar\u0131.<\/div>\n
Barosin\u00fczit tan\u0131s\u0131 i\u00e7in e\u015f zamanl\u0131 geli\u015fen ani bas\u0131n\u00e7 de\u011fi\u015fikli\u011fi ve sin\u00fcste a\u011fr\u0131 gereklidir. A\u011fr\u0131 genellikle al\u0131n veya yanak b\u00f6lgesinde olmakla birlikte g\u00f6z arkas\u0131nda veya \u00fcst di\u015flerde de hissedilebilir. Askeri pilotlarda yap\u0131lan \u00e7al\u0131\u015fmalarda da en s\u0131k semptom al\u0131n b\u00f6lgesinde a\u011fr\u0131 (%97), takiben yanakta a\u011fr\u0131 (%27) ve kanl\u0131 burun ak\u0131nt\u0131s\u0131 (%13-58) olarak bulunmu\u015ftur. Sivillerde de en s\u0131k semptom al\u0131n b\u00f6lgesinde a\u011fr\u0131 iken, kanl\u0131 burun ak\u0131nt\u0131s\u0131 nadiren rapor edilmi\u015ftir. Bu bulgular fizik prensiplere de uygundur. Tipik havayolu seyahatlerinde m\u00fckozal kanamaya sebep olacak kadar b\u00fcy\u00fck bas\u0131n\u00e7 fark\u0131 olu\u015fmaz.<\/div>\n

\n\u00d6nlem ve Tedavi:
\n<\/strong>Barotravmal\u0131 bir hastan\u0131n kapsaml\u0131 de\u011ferlendirmesinde u\u00e7u\u015f \u00f6ncesi risk fakt\u00f6rlerini de kapsayan detayl\u0131 bir t\u0131bbi \u00f6yk\u00fc al\u0131nmas\u0131 \u00f6nceliklidir, daha sonra Weissman s\u0131n\u0131flamas\u0131na g\u00f6re derecelendirmek i\u00e7in radyolojik tetkik yap\u0131l\u0131r. Barotravman\u0131n \u00f6nlenmesindeki ilk basamak risk alt\u0131ndaki ki\u015fileri tespit etmektir. Sivil u\u00e7ucularda en \u00f6nemli u\u00e7u\u015f \u00f6ncesi risk fakt\u00f6rleri akut \u00fcst solunum yolu enfeksiyonu ve alerjik rinit\u2019tir. Her ne kadar askeri u\u00e7ucularda daha s\u0131k g\u00f6r\u00fclse de, sivil u\u00e7ucularda da s\u0131k tekrarlayan barosin\u00fczit ataklar\u0131 sorgulanmal\u0131d\u0131r; \u00e7\u00fcnk\u00fc bu ki\u015filerde altta yatan burun polipleri veya k\u00fcre valf etkisi g\u00f6steren kitleler olabilir.<\/div>\n

Risk alt\u0131ndaki ki\u015filere \u00f6nlem ama\u00e7l\u0131 olarak u\u00e7u\u015ftan \u00f6nce a\u011f\u0131zdan dekonjestan ila\u00e7 ve ini\u015f \u00f6ncesi buruna dekonjestan sprey \u00f6nerilir. Hamileli\u011fin ikinci ve \u00fc\u00e7\u00fcnc\u00fc 3 ayl\u0131k d\u00f6neminde d\u00fc\u015f\u00fck dozlarda ps\u00f6doefedrin ve oksimetazolin kullan\u0131labilirken, ilk 3 ayl\u0131k d\u00f6nemde bunlar bebek i\u00e7in riskli olabilir; bunlar\u0131n yerine u\u00e7u\u015f \u00f6ncesi burunda dekonjesyonu sa\u011flamak i\u00e7in 3 g\u00fcn s\u00fcreyle buruna steroidli sprey uygulanmas\u0131 daha g\u00fcvenli g\u00f6r\u00fclmektedir.<\/p>\n

Askeri havac\u0131l\u0131kta u\u00e7u\u015f s\u0131ras\u0131nda akut barosin\u00fczit geli\u015fti\u011finde pilot irtifa almal\u0131, a\u011fr\u0131s\u0131n\u0131n ge\u00e7ti\u011fi y\u00fcksekli\u011fe \u00e7\u0131kmal\u0131d\u0131r. Buruna dekonjestan sprey s\u0131kma veya Valsalva manevras\u0131 ile bas\u0131n\u00e7 e\u015fitlemeden sonra yava\u015f bir \u015fekilde (d\u00fc\u015f\u00fck varyo ile) irtifa kaybederek ini\u015fe ge\u00e7melidir.
\nBarotravman\u0131n u\u00e7u\u015f sonras\u0131 tedavisinin temeli burnun dekonjesyonudur. Tipik bir tedavi rejimi bir hafta s\u00fcreli burun spreyleri, a\u011fr\u0131 kesiciler, azalan dozda kortizon kullan\u0131m\u0131 ve a\u011f\u0131zdan dekonjestan al\u0131m\u0131ndan olu\u015fur. Borosin\u00fczitin olu\u015fmas\u0131nda bakteriyel bir enfeksiyon etken ise antibiyotik, alerji etken ise antihistaminikler bu tedavi rejimine eklenebilir.<\/p>\n

Akut barosin\u00fczit ge\u00e7iren ki\u015filer altta yatan sebep ve barosin\u00fczitin t\u00fcm bulgular\u0131 ortadan kalkana kadar u\u00e7mamal\u0131d\u0131r. En az\u0131ndan 1 hafta s\u00fcre ile u\u00e7ma, y\u00fczme ve dalma \u00f6nerilmez. Radyografiler 1 hafta sonra tekrarlan\u0131r ve e\u011fer m\u00fckozal kal\u0131nla\u015fma devam ediyorsa hekim u\u00e7u\u015fu 6 haftaya kadar men edebilir. Radyografiler ve bulgular d\u00fczelmi\u015f veya sadece \u00f6nemsiz olan m\u00fckoza alt\u0131 k\u00fc\u00e7\u00fck kanama alanlar\u0131 kalm\u0131\u015f ise u\u00e7u\u015fa izin verilebilir. Alt\u0131nc\u0131 haftada tekrar muayenesi ve kontrol ama\u00e7l\u0131 sin\u00fcslerin bilgisayarl\u0131 tomografisi istenir. \u015eikayeti olmayan ki\u015filerde de hafif m\u00fckozal kal\u0131nla\u015fma olabilece\u011finden, bunun mevcudiyeti u\u00e7u\u015fa engel tek sebep olarak de\u011ferlendirilmemelidir. \u00a0\u015eiddetli bir barosin\u00fczitten sonra pilot kulland\u0131\u011f\u0131 u\u00e7ak tipine g\u00f6re irtifa d\u00fc\u015f\u00fc\u015f\u00fc ayarlanacak bir hipobarik kabin testinden ge\u00e7irilebilir.<\/p>\n

Weissman evre 3 barosin\u00fcziti olan hastalarda yeterli s\u00fcre beklenmesine ra\u011fmen a\u011fr\u0131 ve radyografilerde anormallik devam ederse endoskopik sin\u00fcs cerrahisi ile tedavi g\u00fcndeme gelir.<\/p>\n

Tekrarlay\u0131c\u0131 Barosin\u00fczit:
\n<\/strong>Bu durum s\u0131kl\u0131kla sin\u00fcs m\u00fckozas\u0131nda yeterli iyile\u015fme ger\u00e7ekle\u015fmeden u\u00e7u\u015fa geri d\u00f6n\u00fc\u015f nedeniyle geli\u015fir. Olu\u015fum mekanizmas\u0131n\u0131n, \u015fiddetli barosin\u00fczit s\u0131ras\u0131nda m\u00fckozan\u0131n kemikten ayr\u0131lmas\u0131 (Weissman evre 3) sonucu m\u00fckozada sin\u00fcs a\u011fz\u0131n\u0131n t\u0131kanmas\u0131na neden olabilecek kal\u0131nla\u015fmalara ba\u011fl\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Ayr\u0131ca sin\u00fcs a\u011fz\u0131nda m\u00fckozal \u00f6dem ile birlikte t\u0131kan\u0131kl\u0131\u011fa neden olabilecek kronik sin\u00fczit, burun polipleri, anatomik anormallikler (konka b\u00fclloza, burun e\u011frilikleri, parodoksik orta konka\/unsinat \u00e7\u0131k\u0131nt\u0131) gibi rahats\u0131zl\u0131klar tekrarlay\u0131c\u0131 barosin\u00fczite sebep olabilir.<\/div>\n

\u0130lk basamak tedavi yakla\u015f\u0131m\u0131 antihistaminikler ve buruna uygulanan kortizonlu spreylerdir, ancak bu durumun konservatif tedaviye \u00e7ok iyi cevap vermedi\u011fi ak\u0131lda tutulmal\u0131d\u0131r. Kronik sin\u00fczitten \u015f\u00fcphe ediliyorsa, 1 ayl\u0131k antibiyotik tedavisi verilmelidir. Bulgular d\u00fczeldikten sonra u\u00e7u\u015f g\u00f6revine d\u00f6nmeden \u00f6nce bas\u0131n\u00e7 kabini testinden pilotun ge\u00e7mesi gerekmektedir. T\u0131bbi tedavi ba\u015far\u0131s\u0131z kal\u0131r ve bilgisayarl\u0131 tomografide anatomik problemler tespit edilirse kal\u0131c\u0131 olarak u\u00e7u\u015ftan men edilmeyi \u00f6nlemek i\u00e7in cerrahi tedavi g\u00fcndeme gelir. Endoskopik sin\u00fcs cerrahisi sayesinde eskiden kal\u0131c\u0131 olarak pilotluk yapmaya engel bir durum olarak g\u00f6r\u00fclen tekrarlay\u0131c\u0131 barosin\u00fczit art\u0131k tedavi edilebilir bir hastal\u0131k halini alm\u0131\u015ft\u0131r.<\/p>\n

Sonu\u00e7:<\/strong>
\nBarosn\u00fczit hakk\u0131nda az say\u0131da bilimsel \u00e7al\u0131\u015fma olsa da, olu\u015fum mekanizmalar\u0131 ve fizik prensipleri \u00e7ok iyi \u015fekilde anla\u015f\u0131lm\u0131\u015ft\u0131r. Sivil u\u00e7ak yolcular\u0131nda \u00fcst solunum yolu enfeksiyonu ve allerjiye ba\u011fl\u0131 m\u00fckozal \u00f6dem barosn\u00fczit olu\u015fumu i\u00e7in en \u00f6nemli risk fakt\u00f6rleridir. Bu \u00f6dem u\u00e7u\u015f \u00f6ncesi a\u011f\u0131zdan dekonjestanlar ve u\u00e7u\u015f s\u0131ras\u0131nda ini\u015ften \u00f6nce buruna uygulanacak dekonjestan spreylerle \u00f6nlenmeye \u00e7al\u0131\u015f\u0131l\u0131r. Sivil u\u00e7u\u015flarda geli\u015fen barosn\u00fczitlerde tahribat u\u00e7u\u015f s\u0131ras\u0131ndaki bas\u0131n\u00e7 de\u011fi\u015fiklikleri \u00e7ok fazla olmayaca\u011f\u0131 i\u00e7in genelde Weissman evre I-II \u015feklinde geli\u015fir. Hamilelerde barosn\u00fcziti \u00f6nlemek i\u00e7in ilk 3 ayda buruna kortizonlu spreyler, ikinci ve \u00fc\u00e7\u00fcnc\u00fc 3 aylarda ise d\u00fc\u015f\u00fck dozda standart t\u0131bbi tedavi \u00f6nerilir.<\/div>\n

Akut barosin\u00fczit geli\u015ftikten sonra tedavi a\u011f\u0131zdan ve burundan dekonjestanlar (+ Kortizon) ile yap\u0131l\u0131r. T\u00fcm bulgular ortadan kalkana kadar aral\u0131kl\u0131 t\u0131bbi muayenelerle takip yap\u0131l\u0131r. Cerrahi gerektiren durumlarda endoskopik sin\u00fcs cerrahisinde tecr\u00fcbeli KBB uzman\u0131na ba\u015fvurulmal\u0131d\u0131r. Barosin\u00fczit ge\u00e7irmi\u015f pilotlar ve m\u00fcrettebat, u\u00e7u\u015f ortam\u0131 tekrarlama riskini artt\u0131rd\u0131\u011f\u0131 i\u00e7in daha uzun s\u00fcreli bir rehabilitasyon s\u00fcrecine ihtiya\u00e7 duyar. Askeri u\u00e7ucular daha fazla bas\u0131n\u00e7 de\u011fi\u015fikli\u011fine maruz kald\u0131\u011f\u0131 i\u00e7in \u015fiddetli ve tekrarlay\u0131c\u0131 barosn\u00fczit riski alt\u0131ndad\u0131r. Bu hastalar\u0131n tedavisi ve takibi u\u00e7aklardaki fizyolojik strese dair bilgisi olan u\u00e7u\u015f hekimlerince yap\u0131lmal\u0131d\u0131r.<\/p>\n

Kaynak :<\/strong> Weitzel EK, McMains KC, Rajapaksa S, Wormald P-J. Aerosinusitis: pathophysiology, prophylaxis, and management in passengers and aircrew. Aviat Space Environ Med 2008; 79:50-3.<\/div>\n

\n\u00c7eviri :<\/strong> Do\u00e7. Dr. Erdin\u00e7 Ayd\u0131n\u00a0 (Ba\u015fkent \u00dcniversitesi KBB Anabilim Dal\u0131)<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Sin\u00fcs barotravmas\u0131 Boyle Yasas\u0131 ile a\u00e7\u0131klanabilir. Bu yasaya g\u00f6re sabit s\u0131cakl\u0131kta herhangi bir kuru gaz\u0131n hacmi \u00e7evre bas\u0131nc\u0131 ile ters orant\u0131l\u0131 olarak de\u011fi\u015fir (V=C\/P). Bu yasaya g\u00f6re elastik bir balon i\u00e7indeki gaz, etraf\u0131ndaki bas\u0131n\u00e7 azal\u0131rsa geni\u015fleyecektir, ayn\u0131 u\u00e7u\u015f s\u0131ras\u0131nda y\u00fckselirken oldu\u011fu gibi. Havan\u0131n geni\u015flemesi, (sin\u00fcsler i\u00e7inde oldu\u011fu gibi) nemli gazlarda daha \u00e7abuk olacakt\u0131r. Sin\u00fcs barotravmas\u0131 u\u00e7u\u015fta al\u00e7alma veya y\u00fckselme periyodlar\u0131nda […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-552","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/552","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=552"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/552\/revisions"}],"predecessor-version":[{"id":554,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/552\/revisions\/554"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=552"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=552"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=552"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}