Kirurško liječenje perforacija bubnjića kod djece

master's thesis

• Title (english): Surgical treatment of tympanic membrane perforation in children
• Author: Lorena Stamičar
• Mentor: Lana Kovač Bilić (mentor)
• Committee member: Mario Bilić (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Lana Kovač Bilić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Bubnjić kao dio slušnog aparata ima važnu ulogu u provođenju zvučnog vala pa je stoga perforacija bubnjića patologija koja može predstavljati značajan zdravstveni problem. Perforacija bubnjića češća je u dječjoj dobi, a najčešći je uzrok nastanka perforacije kronična upala srednjeg uha. Upale respiratornog sustava najčešće su među pedijatrijskom populacijom zbog nezrelosti imunološkog sustava i anatomskih specifičnosti te dobi. Osim toga, perforacija može nastati kao rezultat traume ili nekih predisponirajućih faktora koji mogu potencirati razvoj perforacije. Većina perforacija cijeli spontano, ali ukoliko do toga ne dođe nakon višemjesečnog praćenja i konzervativnih metoda liječenja, razmatra se mogućnost kirurškog liječenja. Neki od faktora koji utječu na odluku o operativnom liječenju su dob, etiologija, trajanje perforacije, stanje adenoidnih vegetacija i nepčanih tonzila i stanje kontralateralnog uha, a dvije temeljne pretrage u prijeoperativnoj obradi su otoskopski pregled i audiometrija. Tri su vrste kirurških pristupa na bubnjić, a svaka od njih ima svoje specifičnosti i nedostatke. Također, više je vrsta tkiva koja se mogu koristiti za reparaciju bubnjića te oni mogu biti postavljeni na više načina u odnosu na sam bubnjić. Kod djece s jednostavnim perforacijama nastoji se primijeniti neka od manje invazivnih kirurških metoda s ciljem kraćeg trajanja zahvata i poslijeoperativnog oporavka, a da se pri tom postignu jednako dobri rezultati kao i kod drugih zahvata. Preduvjet za uspješan rezultat timpanoplastike važno je dobro poznavanje i pridržavanje poslijeoperativnih mjera opreza. Za kvalitetnu procjenu uspješnosti operativnog zahvata potrebno je praćenje bolesnika od barem godinu dana. Kao i svaki operativni zahvat, timpanoplastika nosi rizik od nastanka komplikacija kao što su primjerice reperforacija ili nastanak retrakcijskog džepa. Prevencija komplikacija sastoji se od dobrog poznavanja indikacija za timpanoplastiku te poznavanja rizičnih čimbenika pojedinog bolesnika.

Abstract (english)

As a part of the auditory system, tympanic membrane has an important role in the transmission of a soud wave thus tympanic membrane perforation can be a significant health issue. Tympanic membrane perforation is more common in childhood, the most common cause being chronic otitis media. Respiratory tract inflammations are most commonly found among the pediatric population due to immune system immaturity and anatomical specificities. Furthermore, perforation can occur as a result of trauma or certain precipitating factors which can potentiate perforation development. Most perforations heal spotaneously, but if this is not the case even after a follow-up period of a few months and attempts of conservative treatment, surgical treatment options are considered. Some of the factors that influence decision making regarding the surgical treatment are age, etiology, perforation duration, adenoid vegetations and palatine tonsils condition and contralateral ear condition, while the two medical investigations which are considered the most important in the preoperative evaluation are otoscopy and audiometry. There are three types of surgical approaches to reach tympanic membrane and each of these has its specificities and disadvantages. In addition, there are various tissue types that can be used for typanic membrane reparation and they can be positioned in multiple ways towards the tympanic membrane. If a child has a simple perforation, it is preferable to apply one of the less invasive surgical methods which aims to reduce the duration of operation and postoperative recovery, while at the same time accomplishing an outcome as successful as by other methods. Precondition for successful outcome of tympanoplasty is a good knowledge and compliance in terms of postoperative precautionary measures. For a proper evaluation of surgical outcome, a patient follow-up of at least one year period is required. Just like any other surgical procedure, tympanoplasty carries a risk of complications such as reperforation or retraction pocket development. Prevention of complications consists of knowing indications for tympanoplasty and recognizing risk factors for each patient.

• Keywords: perforacija bubnjića; timpanoplastika; komplikacije; djeca
• Keywords (english): tympanic membrane perforation; tympanoplasty; complications; children
• Language: croatian
• URN:NBN: urn:nbn:hr:105:733953
• 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: 2023-10-31 09:29:42