Kronik Otitis Media (KOM)
Özet
Kronik otitis media (KOM), orta kulaktaki enflamasyonun ve kulak zarındaki perforasyon veya adhezyon gibi geri dönüşümsüz değişikliklerin üç aydan uzun sürmesi olarak tanımlanan kronik bir hastalıktır. Düşük sosyoekonomik düzey, kötü hijyen, sigara dumanı, östaki tüpü disfonksiyonu ve mastoid havalanma bozuklukları hastalığın gelişiminde önemli risk faktörleridir. KOM, kolesteatomlu ve kolesteatomsuz olmak üzere iki ana grupta incelenir. Klinik olarak tekrarlayan veya kötü kokulu kulak akıntısı, iletim tipi veya sensörinöral işitme kaybı ve vertigo ile kendini gösterir. Tanı sürecinde otoskopik muayenenin yanı sıra bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MR) gibi radyolojik yöntemlerden yararlanılır. Tedavinin birincil amacı enfeksiyonu ortadan kaldırmak ve kulak fonksiyonlarını yeniden kazandırmaktır. Bu doğrultuda topikal ilaçlar ve aural temizlik gibi cerrahi dışı yöntemlerin yanı sıra timpanoplasti ve mastoidektomi gibi cerrahi yaklaşımlar altın standart olarak uygulanır. Hastalık zamanında tedavi edilmediğinde mastoidit, labirent fistülü ve yüz sinir felci gibi ekstrakraniyal ya da menenjit ve beyin apsesi gibi ölümcül intrakraniyal komplikasyonlara yol açabilir.
Chronic otitis media (COM) is a persistent disease defined as inflammation of the middle ear and irreversible changes in the tympanic membrane, such as perforation or adhesion, lasting for more than three months. Low socioeconomic status, poor hygiene, smoking, Eustachian tube dysfunction, and impaired mastoid pneumatization represent significant risk factors for its development. COM is mainly classified into two categories: with or without cholesteatoma. Clinically, it presents with recurrent or foul-smelling otorrhea, conductive or sensorineural hearing loss, and vertigo. Diagnosis relies on otoscopic examination alongside radiological imaging, including computed tomography (CT) and magnetic resonance imaging (MRI). The primary goal of management is to eradicate the infection and restore functional ear anatomy. Accordingly, non-surgical approaches like topical medications and aural cleaning are utilized, while surgical interventions such as tympanoplasty and mastoidectomy remain the gold standard. If left untreated, COM can lead to severe extracranial complications, including mastoiditis, labyrinthine fistula, and facial nerve palsy, or life-threatening intracranial complications, such as meningitis and brain abscess.
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