{"id":931,"date":"2012-08-11T10:59:56","date_gmt":"2012-08-11T07:59:56","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=931"},"modified":"2012-08-11T10:59:56","modified_gmt":"2012-08-11T07:59:56","slug":"ucusa-bagli-ortaya-cikan-kulak-barotravmalari","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=931","title":{"rendered":"U\u00e7u\u015fa ba\u011fl\u0131 ortaya \u00e7\u0131kan kulak barotravmalar\u0131"},"content":{"rendered":"
\n

\"\"<\/a>Orta kula\u011f\u0131n hava dolu bo\u015fluklar\u0131 temporal kemikteki pn\u00f6matizasyon derecesine g\u00f6re 2.5ml ile 13 ml aras\u0131nda \u00e7ok farkl\u0131 gaz hacmine sahiptir. Orta kulaktaki hava, u\u00e7akta y\u00fckselirken geni\u015fler. Bas\u0131n\u00e7 fark\u0131 20 mbar\u2019a ula\u015f\u0131nca tuba pasif olarak a\u00e7\u0131l\u0131r ve geni\u015fleyen gazlar nazofarenks\u2019e ge\u00e7er.<\/p>\n

Al\u00e7al\u0131\u015f s\u0131ras\u0131nda durum farkl\u0131d\u0131r. \u00c7evre bas\u0131nc\u0131n artmas\u0131na ba\u011fl\u0131 olarak orta kulakta bulunan gaz\u0131n hacmi k\u00fc\u00e7\u00fcl\u00fcr. Bunun e\u015fitlenmesi i\u00e7in nazofarenks\u2019den orta kula\u011fa hava gelmesi gerekir. Ancak tuba\u2019n\u0131n tek y\u00f6nl\u00fc valf mekanizmas\u0131 gibi \u00e7al\u0131\u015fmas\u0131 nedeniyle nazofarenks\u2019den orta kula\u011fa hava g\u00f6nderilmesi pasif olarak ge\u00e7ekle\u015fmez. Bunun i\u00e7in mutlaka yutkunma, esneme gibi hareketler veya bilinen bas\u0131n\u00e7 e\u015fitleme (Valsalva, Frenzel, vb) manevralar\u0131 yard\u0131m\u0131 ile tuba\u2019n\u0131n aktif olarak a\u00e7\u0131lmas\u0131 zorunlulu\u011fu vard\u0131r.<\/p>\n

Fizyolojik \u015fartlar alt\u0131nda mukozan\u0131n rezorpsiyon \u00f6zelli\u011fi nedeniyle orta kulaktaki gaz hacmi azal\u0131r. S\u0131kl\u0131kla fark\u0131nda olmaks\u0131z\u0131n yap\u0131lan yutkunma sayesinde tuba a\u00e7\u0131l\u0131r ve rezorbe olmu\u015f hava tekrar yerine konulmu\u015f olur .<\/p>\n

Bas\u0131n\u00e7 de\u011fi\u015fikli\u011finin \u00e7ok h\u0131zl\u0131 olu\u015ftu\u011fu hallerde (jet sava\u015f u\u00e7aklar\u0131) tuba\u2019n\u0131n aktif olarak a\u00e7\u0131lma zorunlulu\u011fu \u00f6nem g\u00f6steren bir konudur. Bu bas\u0131n\u00e7 e\u015fitlemesi yap\u0131lmad\u0131\u011f\u0131 takdirde nazofarenks ve orta kulak aras\u0131nda bas\u0131n\u00e7 fark\u0131 artar, tuba art\u0131k a\u00e7\u0131lmaz ( tuba blokaj\u0131) ve bas\u0131n\u00e7 fark\u0131 80-120 mbar\u2019a ula\u015ft\u0131\u011f\u0131 takdirde orta ve i\u00e7 kulak barotravmalar\u0131 olu\u015fabilir.<\/p>\n

Barotravmalar<\/p>\n

D\u0131\u015f kulak yolu barotravmas\u0131 (DKYB) :<\/strong> U\u00e7ak g\u00fcr\u00fclt\u00fcs\u00fcn\u00fc azaltmak i\u00e7in kullan\u0131lan kulak t\u0131kac\u0131 veya bu\u015fon ile kulak zar\u0131 aras\u0131nda olu\u015fan haval\u0131 sahadan kaynaklan\u0131r. Al\u00e7al\u0131\u015f s\u0131ras\u0131nda bu haval\u0131 bo\u015fluktaki gaz k\u00fc\u00e7\u00fcl\u00fcr. Bunun sonucu olarak d\u0131\u015f kulak yolu derisi ve kulak zar\u0131n\u0131n epitel tabakas\u0131nda hemorajik b\u00fcller meydana gelir. D\u0131\u015f kulak yolu osteomlar\u0131 ve yabanc\u0131 cisimleri de DKYB\u2019na neden olabilen fakt\u00f6rlerdir.<\/p>\n

Orta kulak barotravmas\u0131 (aerotitis media) :<\/strong> Orta kulaktaki bas\u0131n\u00e7 azl\u0131\u011f\u0131n\u0131 kompanse etmek i\u00e7in bas\u0131n\u00e7 e\u015fitleme manevralar\u0131 ge\u00e7 yap\u0131lacak olursa , bas\u0131n\u00e7 fark\u0131 80-120 cc su bas\u0131nc\u0131na ula\u015f\u0131r ve tuba art\u0131k a\u00e7\u0131lmayabilir (tuber blokaj). Tuba\u2019n\u0131n a\u00e7\u0131lma s\u0131kl\u0131\u011f\u0131 jet sava\u015f u\u00e7aklar\u0131nda, dal\u0131\u015flarda dakikada 3-5 kez, pike yapan u\u00e7aklarda ise 15-20 kez olmal\u0131d\u0131r.<\/p>\n

Barotravma\u2019lar\u0131n meydana \u00e7\u0131k\u0131\u015f\u0131nda di\u011fer bir etken, tuba\u2019n\u0131n ge\u00e7irgenlik derecesi ve tuba \u00e7evresindeki epitel ile \u00e7evre dokular\u0131n durumudur. Ba\u015flang\u0131\u00e7ta kulak zar\u0131nda retraksiyon olur. B\u00f6ylelikle orta kulaktaki bas\u0131n\u00e7 azalmas\u0131 %10\u2019a kadar e\u015fitlenebilir . Bas\u0131n\u00e7 azalmas\u0131 devam etti\u011fi takdirde \u00f6nce manibrium mallei \u00fczerinde, daha sonra t\u00fcm kulak zar\u0131nda hiperemi meydana gelir. Daha sonra hemorajik b\u00fcller olu\u015fur. Orta kulaktaki d\u00fc\u015f\u00fck bas\u0131n\u00e7 vantuz mekanizmas\u0131yla orta kulak mukozas\u0131nda \u00f6dem yarat\u0131r, subm\u00fck\u00f6z hemoraji g\u00f6r\u00fcl\u00fcr.<\/p>\n

Orta kulak bo\u015flu\u011funda ser\u00f6z ve hemorajik eksuda meydana gelir. Eksuda, orta kulaktaki negatif bas\u0131nc\u0131 dengelemek i\u00e7in damar \u00e7eperlerinin ge\u00e7irgenli\u011finin bozulmas\u0131yla ortaya \u00e7\u0131kan negatif bas\u0131n\u00e7 derecesine g\u00f6re az veya \u00e7ok olabilir. Bu s\u0131ralarda tuba a\u00e7\u0131l\u0131r ve bas\u0131n\u00e7 dengelemesi olursa eksuda kaybolur. E\u011fer tedavi edilmezse ve s\u0131k s\u0131k yinelerse timpanoskleroz\u2019a d\u00f6n\u00fc\u015febilir. Bas\u0131n\u00e7 fark\u0131 0.4-0.6 bar\u2019dan itibaren kulak zar\u0131n\u0131n y\u0131rt\u0131lmas\u0131na neden olur. Perforasyon genellikle \u00e7izgi bi\u00e7iminde ve kenarlar\u0131 kanl\u0131d\u0131r.<\/p>\n

Bas\u0131n\u00e7 fark\u0131 20 mbar\u2019dan itibaren kulak a\u011fr\u0131s\u0131na neden olur. Kulakta dolgunluk hissi, u\u011fultu, fenal\u0131k hissi, bulant\u0131, ba\u015f d\u00f6nmesi ve i\u015fitme eksikli\u011fi g\u00f6r\u00fcl\u00fcr.<\/p>\n

\u00c7evre bas\u0131nc\u0131n\u0131n azalmas\u0131 yani u\u00e7akla y\u00fckseli\u015f s\u0131ras\u0131nda orta kulaktaki gazlar geni\u015fler. E\u011fer \u00f6staki borusunda geni\u015fleyen gaz\u0131n nazofarenks\u2019e ge\u00e7mesini engelleyecek (iltihap, polip,vb) bir durum varsa, gaz orta kulakta birikir. Zar d\u0131\u015far\u0131 do\u011fru itilir. Kulakta dolgunluk hissi, i\u015fitme kayb\u0131, kulak a\u011fr\u0131s\u0131 ve ba\u015f d\u00f6nmesi g\u00f6r\u00fcl\u00fcr. E\u011fer \u00f6staki borusunda geni\u015fleyen gaz\u0131n nazofarenks\u2019e rahat\u00e7a ge\u00e7mesini engelleyen bir patoloji yoksa, bu ge\u00e7i\u015f pasif olarak yap\u0131laca\u011f\u0131ndan y\u00fckseli\u015f s\u0131ras\u0131nda barotravma olma olas\u0131l\u0131\u011f\u0131 azd\u0131r.<\/p>\n

Orta kulak barotravma\u2019s\u0131n\u0131n sebebi u\u00e7u\u015f s\u0131ras\u0131ndaki hava bas\u0131nc\u0131 de\u011fi\u015fikliklerinde yatmaktad\u0131r. \u00c7o\u011funlukla \u00fcst solunum yollar\u0131nda akut bir enfeksiyon vard\u0131r. Bunun d\u0131\u015f\u0131nda paranazal sin\u00fcs enfeksiyonlar\u0131, nazal polip, allerjik rinit gibi tuba a\u011fz\u0131ndaki mukozada iltihap ve \u00f6dem yapan fakt\u00f6rler tubuler fonksiyonun bozulmas\u0131na neden olurlar. En s\u0131k kar\u015f\u0131la\u015f\u0131lan etyolojik fakt\u00f6r ise anterior etmoid h\u00fccre sistemindeki iltihaplard\u0131r. Ayr\u0131ca tuba a\u00e7\u0131kl\u0131\u011f\u0131 sa\u011fl\u0131kl\u0131 ki\u015filerde bile ayn\u0131 ge\u00e7irgenlikte de\u011fildir.<\/p>\n

U\u00e7ucular\u0131n se\u00e7ilme prosed\u00fcrlerinde tubal fonksiyonlar\u0131n dikkatle de\u011ferlendirilmesi, u\u00e7u\u015f esnas\u0131nda \u00f6staki borusunun sa\u011fl\u0131kl\u0131 \u00e7al\u0131\u015fmamas\u0131na ba\u011fl\u0131 olarak geli\u015febilecek orta kulak patolojilerini \u00f6nceden bilmek a\u00e7\u0131s\u0131ndan \u00f6nem ta\u015f\u0131r . U\u00e7ucu se\u00e7imlerinde Valsalva manevras\u0131 yapt\u0131rarak tuba \u00f6staki fonksiyonlar\u0131 hakk\u0131nda yeterli bilgi sahibi olunamaz. Pilotaj muayenelerinde bu ama\u00e7la timpanometri kullan\u0131lmal\u0131d\u0131r. Hatta basit bir timpanogram\u0131n performans\u0131 bile orta kulak barotravma riskini g\u00f6stermeye yeterli de\u011fildir.<\/p>\n

\u0130\u00e7 kulak barotravma (\u0130KBT) :<\/strong> \u0130\u00e7 kulak barotravma\u2019s\u0131n\u0131n olu\u015fma mekanizmas\u0131 i\u00e7in sadece hipotez mevcuttur. Tuba fonksiyon bozuklular\u0131nda u\u00e7ucu, al\u00e7al\u0131\u015f s\u0131ras\u0131nda orta kulaktaki gaz hacmini e\u015fitlemek i\u00e7in \u015fiddetle orta kula\u011fa hava vermesi veya zorlu bir Valsalva s\u0131ras\u0131nda \u00f6stakinin birden a\u00e7\u0131lmas\u0131 sonucu orta kula\u011fa aniden bas\u0131n\u00e7l\u0131 hava g\u00f6nderilmesi sonucu yuvarlak pencereyi \u00f6rten segonder zar perilenfe do\u011fru bombe yapar ve r\u00fcpt\u00fcre olabilir. Bu mekanizma eksplosiv i\u00e7 kulak barotravmas\u0131 olarak adland\u0131r\u0131l\u0131r . D\u00fc\u015f\u00fcn\u00fclen di\u011fer bir mekanizma ise implosiv mekanizma olup, tuba\u2019y\u0131 a\u00e7mak amac\u0131yla kuvvetli bir Valsalva manevras\u0131 tatbik edildi\u011fi zaman lik\u00f6r bas\u0131nc\u0131n\u0131n artmas\u0131 sonucu, geni\u015f aquaduktus koklea bulunan olgularda bas\u0131n\u00e7 perilenfe iletilir ve sonu\u00e7ta yuvarlak pencere orta kula\u011fa do\u011fru bombele\u015fir ve r\u00fcpt\u00fcr meydana gelebilir.<\/p>\n

Semptomlar ani i\u00e7 kulak tipi i\u015fitme kayb\u0131, tinnitus, vertigo ve denge kayb\u0131d\u0131r.<\/p>\n

Tedavi<\/p>\n

Profilaksi: Bas\u0131n\u00e7 e\u015fitleme tekni\u011fi, bas\u0131n\u00e7 e\u015fitleme bozuklu\u011fu olan her u\u00e7ucu ile konu\u015fulmal\u0131 ve kontrol edilmelidir. Orta ve i\u00e7 kulak Barotravmalar\u0131ndan ka\u00e7\u0131nmak i\u00e7in bas\u0131n\u00e7 e\u015fitleme manevralar\u0131 mutlaka yap\u0131lmal\u0131d\u0131r. En iyi profilaksi bunun bilinmesi olup, bas\u0131n\u00e7 e\u015fitlemenin zaman\u0131nda ve do\u011fru yap\u0131lmas\u0131d\u0131r gereklidir.<\/p>\n

U\u00e7ucu se\u00e7imi de profilakside \u00e7ok \u00f6nemli yer kaplar. Pilotaj muayeneleri esnas\u0131nda u\u00e7u\u015fa engel te\u015fkil edecek hastal\u0131klar\u0131n belirlenerek bu ki\u015filerin u\u00e7malar\u0131n\u0131n engellenmesi gerekmektedir.<\/p>\n

Yolcular a\u00e7\u0131s\u0131ndan ; yolcular\u0131n yere ini\u015f s\u0131ras\u0131nda uyumalar\u0131 sak\u0131ncal\u0131d\u0131r. Aksi takdirde bas\u0131n\u00e7 fark\u0131 b\u00fcy\u00fck olmakta ve tuba blokaj\u0131 meydana gelebilmektedir. Bas\u0131n\u00e7 e\u015fitlemede sak\u0131z \u00e7i\u011fnemek, ufak yudumlarla su almak, bebeklere biberondan s\u0131v\u0131 i\u00e7ermek uygundur. \u00dcSYE, sin\u00fczit, farenjit, tonsillit gibi durumlarda u\u00e7ulmamal\u0131d\u0131r. Yap\u0131lan \u00e7al\u0131\u015fmalarda daha evvel u\u00e7u\u015f s\u0131ras\u0131nda kulak ve sin\u00fcs a\u011fr\u0131s\u0131 \u00e7eken hava yolu yolcular\u0131nda \u00f6zellikle \u00e7ocuklarda barotitis geli\u015fme riski fazlad\u0131r. Valsalva manevras\u0131 \u00e7ocuklar\u0131n 1\/3\u2019 de, yeti\u015fkinlerin ise yar\u0131s\u0131nda orta kulaktaki negatif bas\u0131nc\u0131 d\u00fczeltmede yeterli olmaktad\u0131r. Ancak Valsalva manevras\u0131n\u0131n ba\u015far\u0131s\u0131z olmas\u0131 halinde u\u00e7a\u011f\u0131n al\u00e7al\u0131\u015f\u0131 s\u0131ras\u0131nda veya daha evvel Otovent \u015fi\u015firmenin \u00e7ocuklarda ve yeti\u015fkinlerde etkili oldu\u011fu g\u00f6sterilmi\u015ftir .<\/p>\n

Alternobarik vertigonun tedavisi de profilaktiktir. U\u00e7ucular\u0131n \u00dcSYE, sin\u00fczit, farenjit gibi durumlarda u\u00e7malar\u0131na engel olunulmas\u0131, b\u00f6yle bir tablonun ortaya \u00e7\u0131kmas\u0131na mani olacakt\u0131r.<\/p>\n

D\u0131\u015f kulak yolu barotravmas\u0131 :<\/strong> D\u0131\u015f kulak yolundaki ufak hemorajik sahalar tedavi gerektirmez. Ancak b\u00fcy\u00fck hemorajik b\u00fcller enjekt\u00f6r yard\u0131m\u0131 ile veya insize edilerek bo\u015falt\u0131l\u0131r. D\u0131\u015f kulak yolu Castellani sol\u00fcsyonu ile temizlendikten sonra terracortril pomat ile bulanm\u0131\u015f steril bez yahut weak kulak yoluna yerle\u015ftirilir.<\/p>\n

Orta ve i\u00e7 kulak barotravma :<\/strong> Orta kulak barotravmalar\u0131n da; s\u0131cak tatbikat\u0131, antibiyotik, antienflamatuar, mukolitik, topikal ve sistemik p\u00f6doefedrinli ila\u00e7lar verilir. Orta kulakta ser\u00f6zite varsa parasentez yap\u0131larak bo\u015falt\u0131l\u0131r. U\u00e7u\u015fa tubal fonksiyonlar d\u00fczelinceye kadar m\u00fcsaade edilmez. Kronik tuba disfonksiyonlar\u0131nda havaland\u0131rma t\u00fcp\u00fc yerle\u015ftirilir. U\u00e7ucunun i\u015fitme sorunu yoksa, havaland\u0131rma t\u00fcp\u00fc ile u\u00e7mas\u0131nda sak\u0131nca yoktur.<\/p>\n

Travmatik perforasyon olu\u015fmas\u0131 halinde zorunlu olmamakla birlikte \u00f6nlem olarak yukar\u0131daki tedavi verilir ve ek olarakta u\u00e7ucunun bir s\u00fcre s\u00fcmk\u00fcrmemesi istenir. B\u00fcy\u00fck perforasyonlar ise miringoplasti ile kapat\u0131l\u0131r.<\/p>\n

E\u011fer r\u00fcpt\u00fcr \u015f\u00fcphesi varsa timpanotomi yap\u0131lmal\u0131 ve fist\u00fcl kapat\u0131lmal\u0131d\u0131r.<\/p>\n

Yaz\u0131y\u0131 haz\u0131rlayan :<\/strong> Do\u00e7. Dr. M. Faruk Ild\u0131z<\/p>\n

KBB Ba\u015f ve Boyun Cerrahisi Uzman\u0131 & U\u00e7u\u015f Doktoru<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Orta kula\u011f\u0131n hava dolu bo\u015fluklar\u0131 temporal kemikteki pn\u00f6matizasyon derecesine g\u00f6re 2.5ml ile 13 ml aras\u0131nda \u00e7ok farkl\u0131 gaz hacmine sahiptir. Orta kulaktaki hava, u\u00e7akta y\u00fckselirken geni\u015fler. Bas\u0131n\u00e7 fark\u0131 20 mbar\u2019a ula\u015f\u0131nca tuba pasif olarak a\u00e7\u0131l\u0131r ve geni\u015fleyen gazlar nazofarenks\u2019e ge\u00e7er. Al\u00e7al\u0131\u015f s\u0131ras\u0131nda durum farkl\u0131d\u0131r. \u00c7evre bas\u0131nc\u0131n artmas\u0131na ba\u011fl\u0131 olarak orta kulakta bulunan gaz\u0131n hacmi k\u00fc\u00e7\u00fcl\u00fcr. Bunun e\u015fitlenmesi i\u00e7in nazofarenks\u2019den orta […]<\/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-931","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\/931","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=931"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/931\/revisions"}],"predecessor-version":[{"id":933,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/931\/revisions\/933"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=931"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=931"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=931"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}