{"id":655,"date":"2012-07-22T10:39:18","date_gmt":"2012-07-22T07:39:18","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=655"},"modified":"2012-07-22T10:39:18","modified_gmt":"2012-07-22T07:39:18","slug":"ucucularda-meniere-hastaligi","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=655","title":{"rendered":"U\u00e7ucularda Meniere Hastal\u0131\u011f\u0131"},"content":{"rendered":"<div>\n<p style=\"text-align: justify;\"><a href=\"http:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/meniere.jpg\"><img fetchpriority=\"high\" decoding=\"async\" class=\"alignleft size-full wp-image-656\" title=\"meniere\" src=\"http:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/meniere.jpg\" alt=\"\" width=\"300\" height=\"248\" srcset=\"https:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/meniere.jpg 300w, https:\/\/www.hvtd.org\/wp-content\/uploads\/2012\/07\/meniere-66x55.jpg 66w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a>Meniere hastal\u0131\u011f\u0131, ani oryantasyon bozuklu\u011fu ve ne zaman ortaya \u00e7\u0131kaca\u011f\u0131 bilinmeyen vertigo ataklar\u0131na sebep olabilece\u011finden u\u00e7ucular i\u00e7in \u00e7ok b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r.<br \/>\n<strong><\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Olgu 1:<\/strong> 46 ya\u015f\u0131nda, erkek, ticari havayolu pilotu olarak yakla\u015f\u0131k 13 bin saatlik u\u00e7u\u015f tecr\u00fcbesine sahip olup, 1. S\u0131n\u0131f sa\u011fl\u0131k sertifikas\u0131n\u0131n yenilenmesi gerek\u00e7esiyle ba\u015fvurmu\u015f. Zaman zaman bir tiazid grubu di\u00fcretik (Diazide) ile tinnitus ve kulak t\u0131kanmas\u0131 sorununun kontrol alt\u0131na al\u0131nmaya \u00e7al\u0131\u015f\u0131ld\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n<p style=\"text-align: justify;\">Pilota AME taraf\u0131ndan 3 haftadan daha uzun bir s\u00fcre Diazide kulland\u0131\u011f\u0131nda serum potasyum d\u00fczeyini kontrol ettirmesinin gerekti\u011fi belirtilerek 1. S\u0131n\u0131f sa\u011fl\u0131k sertifikas\u0131 verilmi\u015ftir. Pilot 1 hafta sonra, birka\u00e7 saat s\u00fcren ve odan\u0131n d\u00f6nmesi \u015feklinde tan\u0131mlad\u0131\u011f\u0131 bir sersemlik yak\u0131nmas\u0131yla KBB uzman\u0131na ba\u015fvurmu\u015f. Yap\u0131lan de\u011ferlendirmede, sol kulak dolgunlu\u011fu, inflamasyonu ve ayn\u0131 kulakta giderek artan i\u015fitme kayb\u0131 \u015fikayetlerinin 3.5 y\u0131ld\u0131r devam etmekte oldu\u011fu anla\u015f\u0131lm\u0131\u015f. Odyometri testi, Elektronistagmografi (ENG), MRI ve kan tetkikleri incelenmi\u015f ve sonu\u00e7lar\u0131 normal bulunmu\u015f. Pilotun intermittent ba\u015f d\u00f6nmesi ataklar\u0131, kulak dolgunlu\u011fu, i\u015fitme kayb\u0131, tinnitus \u015fikayetleri d\u00fc\u015f\u00fck tuz i\u00e7eren diyet ve maksimal di\u00fcretik tedavisine ra\u011fmen haftalarca devam etmi\u015f.<\/p>\n<p style=\"text-align: justify;\">\u0130lk vertigo ata\u011f\u0131ndan 2 ay sonra hastaya elektif sol endolenfatik kese dekompresyonu ve \u015fant yerle\u015ftirilmesi operasyonu uyguland\u0131. Ameliyat\u0131 takip eden haftalarda ba\u015f d\u00f6nmesi ile kulakta bas\u0131n\u00e7 sorunlar\u0131n\u0131n kayboldu\u011fu, ancak sol kulakta i\u015fitme kayb\u0131n\u0131n devam etti\u011fi g\u00f6r\u00fcld\u00fc. Ameliyat\u0131 sonras\u0131 ba\u015f d\u00f6nmesi olmadan ge\u00e7en 6 ayl\u0131k s\u00fcrecin sonunda FAA taraf\u0131ndan k\u0131s\u0131tl\u0131 medikal yetkilendirme (waiver) belgesi verildi. 2 ay sonra tekrar ba\u015flayan \u015fiddetli ba\u015f d\u00f6nmesi ataklar\u0131 nedeni ile KBB uzman\u0131na ba\u015fvuran hastan\u0131n t\u0131bbi sertifikasyonu FAA taraf\u0131ndan ge\u00e7ersiz say\u0131ld\u0131 ve \u015fahs\u0131n da iste\u011fi ile iptal edildi.<\/p>\n<p style=\"text-align: justify;\">Sonraki aylarda episodik semptomlar\u0131n devam etmesi \u00fczerine, KBB taraf\u0131ndan ileri terap\u00f6tik opsiyonlar tart\u0131\u015f\u0131ld\u0131 ve parsiyel sinir ablasyonu i\u00e7in orta kula\u011fa miringotomi yoluyla tek bir intratimpanik gentamisin enjeksiyonu yap\u0131ld\u0131. Bu i\u015flem normal i\u015fitme ve denge fonksiyonlar\u0131n\u0131 olumsuz etkilemeden Meniere semptomlar\u0131n\u0131 ortadan kald\u0131rmaktad\u0131r. Bu tedaviyi takiben ba\u015f d\u00f6nmeleri ge\u00e7ti\u011fi gibi, f\u0131s\u0131lt\u0131l\u0131 konu\u015fmalar\u0131 dahi duyabilecek yeterlilikte i\u015fitme fonksiyonu oldu\u011fu g\u00f6r\u00fcld\u00fc. Parsiyel ablasyon i\u015flemini takip eden 3 ay boyunca ba\u015f d\u00f6nmesi olmamas\u0131 \u00fczerine u\u00e7ucu t\u0131bbi sertifika i\u00e7in tekrar ba\u015fvurdu. Destekleyen dok\u00fcmanlar aras\u0131nda sol kulakta hafif derece i\u015fitme kayb\u0131n\u0131 g\u00f6steren odyogram ve sol vestibuler sistemde parsiyel supresyonu g\u00f6steren ENG sonu\u00e7lar\u0131 vard\u0131. Havac\u0131l\u0131k T\u0131bbi Sertifikasyon B\u00f6l\u00fcm\u00fc vakay\u0131 yeniden de\u011ferlendirmek \u00fczere bir KBB uzman\u0131na y\u00f6nlendirdi.<\/p>\n<p style=\"text-align: justify;\">Subtotal ablasyon uygulanan hastalarda Meniere\u2019in \u00f6ng\u00f6r\u00fclemeyen durumu ve her an \u015fikayetlerinin tekrarlayabilece\u011fi olas\u0131l\u0131\u011f\u0131 nedeniyle KBB uzman\u0131 hastan\u0131n yeniden aktif g\u00f6reve d\u00f6nmesinin reddini \u00f6nermi\u015f; pilota cerrahi veya farmakolojik total ablasyon uygulanmas\u0131n\u0131n uygun olaca\u011f\u0131n\u0131 da belirtmi\u015ftir. Bu tavsiyeleri do\u011frultusunda pilotun t\u0131bbi sertifikasyonu reddedilmi\u015ftir.<br \/>\n<strong>Havac\u0131l\u0131k T\u0131bb\u0131 Y\u00f6nergeleri:<\/strong> Ge\u00e7erli FAA politikas\u0131na g\u00f6re, her ne sebeple olursa olsun, vertigo tam olarak kaybolana kadar t\u0131bbi sertifikasyon s\u00f6z konusu olamaz. Pilot u\u00e7u\u015f yapt\u0131\u011f\u0131 s\u00fcrece, vertigo i\u00e7in g\u00fcnl\u00fck tedavi al\u0131yor olmamal\u0131d\u0131r veya tedavi al\u0131yorsa u\u00e7u\u015fu durdurulmal\u0131d\u0131r. Aktif Meniere hastal\u0131\u011f\u0131 olan hi\u00e7bir u\u00e7ucu i\u00e7in sertifikasyon s\u00f6z konusu de\u011fildir. Sertifikasyon ancak, e\u011fer hastal\u0131k 3 ayd\u0131r remisyonda ise ve KBB uzman\u0131 de\u011ferlendirmesi ile belgeli ise s\u00f6z konusu olabilir. \u0130lk remisyondan sonra vertigonun tekrarlamas\u0131 halinde sertifikasyon m\u00fcmk\u00fcn de\u011fildir. Komplike vakalar de\u011ferlendirilmek \u00fczere FAA Havac\u0131l\u0131k T\u0131bb\u0131 Sertifikasyon B\u00f6l\u00fcm\u00fcne y\u00f6nlendirilir.<br \/>\n<strong>Vakan\u0131n Son Durumu:<\/strong> FAA\u2019n\u0131n u\u00e7u\u015f m\u00fcsaadesi vermemesi \u00fczerine pilot Federal U\u00e7u\u015f Doktoruna m\u00fcracaat etti. KBB uzman\u0131n\u0131n pozitif bulgular\u0131, daha \u00f6nceki kay\u0131tlar\u0131n\u0131n incelemesi ve sinir ablasyonu ile elde edilen d\u00fczelmeler \u0131\u015f\u0131\u011f\u0131nda hastan\u0131n talebi olumlu kar\u015f\u0131land\u0131 ve hastaya 6 ayl\u0131k zaman-s\u0131n\u0131rl\u0131 \u00f6zel 1. S\u0131n\u0131f sertifikasyon (waiver) verildi (1).<br \/>\n<strong>Olgu 2:<\/strong> 43 ya\u015f\u0131nda askeri jet pilotu. 8 y\u0131l \u00f6nce ba\u015f d\u00f6nmesi yak\u0131nmas\u0131 nedeniyle ila\u00e7 tedavisine al\u0131narak u\u00e7u\u015fu kesilmi\u015f; tedavinin yararl\u0131 olmamas\u0131 \u00fczerine bir n\u00f6rolo\u011fa g\u00f6nderilmi\u015f. Tedavi olarak bir mikro kateter ile yuvarlak pencereden gentamisin enjeksiyonu yap\u0131lm\u0131\u015f. 1 y\u0131l sonra hafif semptomlarla seyreden bir remisyon d\u00f6neminde tek kumandal\u0131 bir jet olan F-18 Hornet\u2019lerde u\u00e7ma talebinde bulunmu\u015f ama reddedilmi\u015f. Pilotun U\u00e7u\u015f Doktorlar\u0131 Board\u2019\u0131na \u00e7\u0131kma iste\u011fi kabul edilmi\u015f; burada yap\u0131lan de\u011ferlendirilme sonucu, waiver stat\u00fcs\u00fcnde u\u00e7u\u015f verilmi\u015f. Ancak 2 y\u0131l sonraki bir sava\u015f u\u00e7u\u015funda vertigo ortaya \u00e7\u0131kmas\u0131 nedeniyle waiver durumu iptal edilmi\u015f; ancak hastan\u0131n n\u00f6rologu, vertigo epizodunun Meniere\u2019e de\u011fil, bir vestib\u00fcler n\u00f6ronitis\u2019e ba\u011fl\u0131 oldu\u011funu ve tamamen iyile\u015fti\u011fini, jet u\u00e7u\u015flar\u0131na d\u00f6nebilece\u011fini bildirmi\u015f (2).<\/p>\n<p style=\"text-align: justify;\">Bu olgu, her ba\u015f d\u00f6nmesi yak\u0131nmas\u0131n\u0131n Meniere gibi ciddi bir hastal\u0131\u011fa ba\u011fl\u0131 olmayabilece\u011fini; olsa bile havac\u0131l\u0131k t\u0131bb\u0131 de\u011ferlendirmesinde hem u\u00e7u\u015f riski, hem de pilotun mesleki kariyeri a\u00e7\u0131lar\u0131ndan ne kadar titizlikle karar vermeyi gerekti\u011fini \u00f6rneklemesi bak\u0131m\u0131ndan ilgin\u00e7tir.<br \/>\n<strong><\/strong><\/p>\n<p style=\"text-align: justify;\"><strong>Kaynaklar:<\/strong><\/p>\n<p style=\"text-align: justify;\">1. West KN. An aviator with Meniere\u2019s Disease. The Federal Air Surgeon\u2019s Medical Bulletin, 2007-1;6-7<\/p>\n<p style=\"text-align: justify;\">2. Phelan J. Meniere\u2019s Disease in a military fast-jet pilot. Risk management with variable quality evidence. 78th Annual AsMA Scientific Meeting (2007) Abs.# 155<\/p>\n<p style=\"text-align: justify;\"><strong>Haz\u0131rlayan :<\/strong> Dr. M. Erkan KAHRAMAN Eski\u015fehir Asker Hastanesi KBB Uzman\u0131<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Meniere hastal\u0131\u011f\u0131, ani oryantasyon bozuklu\u011fu ve ne zaman ortaya \u00e7\u0131kaca\u011f\u0131 bilinmeyen vertigo ataklar\u0131na sebep olabilece\u011finden u\u00e7ucular i\u00e7in \u00e7ok b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r. Olgu 1: 46 ya\u015f\u0131nda, erkek, ticari havayolu pilotu olarak yakla\u015f\u0131k 13 bin saatlik u\u00e7u\u015f tecr\u00fcbesine sahip olup, 1. S\u0131n\u0131f sa\u011fl\u0131k sertifikas\u0131n\u0131n yenilenmesi gerek\u00e7esiyle ba\u015fvurmu\u015f. Zaman zaman bir tiazid grubu di\u00fcretik (Diazide) ile tinnitus ve kulak t\u0131kanmas\u0131 sorununun kontrol alt\u0131na [&hellip;]<\/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-655","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\/655","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=655"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/655\/revisions"}],"predecessor-version":[{"id":657,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/655\/revisions\/657"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=655"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=655"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=655"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}