Kirurško liječenje provodnog oštećenja sluha uzrokovanog kroničnom upalom srednjeg uha

master's thesis

• Title (english): Surgical treatment of conductive hearing loss caused by chronic otitis media
• Author: Lucija Hoblaj
• Mentor: Andro Košec (mentor)
• Committee member: Jakov Ajduk (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Andro Košec (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Kronična upala srednjeg uha je upalni proces trajanja dužeg od šest tjedana. Karakterizira je otoreja i provodno oštećenje sluha, uglavnom bez prisutnosti boli. Kronična upala srednjeg uha javlja se kako u djece, tako i u odraslih i uzrokom je više od osamdeset posto oštećenja lanca slušnih košćica. Postoje četiri vrste kronične upale srednjeg uha, kronična serozna upala srednjeg uha, kronična gnojna upala srednjeg uha, kronična upala srednjeg uha s priraslicama te kronična upala srednjeg uha s kolesteatomom. Početna terapija uključuje primjenu antibiotika. U slučaju neuspješnosti terapije, razmatra se kirurška intervencija. Indikacije za operaciju uključuju pojavu otogenih komplikacije (provodno oštećenje sluha), razvoj kolesteatoma i ostitičkog procesa, rupturu lanca slušnih košćica i perzistentnu perforaciju bubnjića. Glavni ciljevi operacije su eradikacija patološkog procesa u srednjem uhu, zatvaranje perforacije bubnjića i rekonstrukcija lanca slušnih košćica. Zato se operacija zove timpanoplastika s osikuloplastikom. Postoje tri pristupa operativnom polju srednjeg uha, od kojih se najčešće primjenjuje endauralni pristup. Nakon pristupa srednjem uhu, u slučaju oštećenja lanca slušnih košćica, provodi se osikuloplastika. S obzirom na oštećen dio lanca slušnih košćica, operacije se individualiziraju. Najčešće nedostaje inkus ili njegov dio. Operacija uključuje uporabu autologne slušne košćice, ako je to moguće, koja se oblikuje trimanjem i postavlja na uobičajeno mjesto u lancu slušnih košćica. U slučaju nemogućnosti primjene autolognih presadaka, mogu se koristiti heterologni ili aloplastični presadci. U slučaju perforacije bubnjića izvodi se timpanoplastika. Presadci uključuju fasciju, perihondrij i najčešće primjenjivanu, hrskavicu. Timpanoplastika s osikuloplastikom je uspješan način liječenja provodnog oštećenja sluha nakon kronične upale srednjeg uha jer poboljšava sluh uz postojanje niske stope komplikacija.

Abstract (english)

Chronic otitis media is an inflammation of the middle ear which persists longer than six weeks. It is characterised by otorrhoea and conductive hearing loss, usually without the presence of pain. Chronic otitis media occurs in both, children and adults, and it is the most common cause of disruption of the auditory ossicle chain, including more than eighty percent of causes. There are four types of chronic otitis media, chronic serous otitis media, chronic suppurative otitis media, chronic otitis media with adhesions and chronic otitis media with cholesteatoma. The treatment starts with antibiotic therapy. If the therapy is unsuccessful, surgical approach is considered. Indications for surgical treatment are appearance of otogenic complications (conductive hearing loss), cholesteatoma and ostitic process, rupture of auditory ossicle chain and persistent perforation. The main goals of surgery are eradication of the pathological process in the middle ear, closure of the eardrum perforation and reconstruction of the auditory ossicle chain. Therefore, the operation is called tympanoplasty with ossiculoplasty. There are three possible approaches to the operating area with endaural approach most commonly used. After approaching the operating area of the middle ear, in presence of ossicle chain damage, ossiculoplasty is performed. Given the finding of the damaged part of the auditory ossicle chain, operations are individualised. Mostly, the incus or a part of the incus is missing. The operation includes reuse of the autologous ossicle if possible, which can be shaped by drilling and placed to its usual place in the chain. If autologic grafts can't be used, other options include heterologous or alloplastic grafts. If eardrum perforation is present, tympanoplasty is performed. Grafts which are used include fascia, perichondrium and most frequently used, cartilage. Tympanoplasty with ossiculoplaty is a successful way of treatment of conductive hearing loss after chronic otitis media. It improves hearing status satisfactorily with low complications rate.

• Keywords: kronična upala srednjeg uha; otoreja; provodno oštećenje sluha; timpanoplastika; osikuloplastika; rekonstrukcija lanca slušnih košćica
• Keywords (english): chronic otitis media; otorrhoea; conductive hearing loss; tympanoplasty; ossiculoplasty; ossicular chain reconstruction
• Language: croatian
• URN:NBN: urn:nbn:hr:105:158016
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-09 10:24:52