Gastroözefageal reflü hastalığının efüzyonlu otitis media etyolojisi ve tedavisindeki rolü /
Yazar: FATİH YÜKSEL
Danışman: PROF.DR. İSMAİL KÜLAHLI
Erciyes Üniversitesi / Tıp Fakültesi / Kulak Burun Boğaz Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2006
Konu: Kulak Burun ve Boğaz = Otorhinolaryngology (Ear-Nose-Throat)

Özet:
ÖZETAmaç: Bu çal mada çocuklarda gastroözefageal reflü hastal H n n, efüzyonluotitis media etyolojisi ve tedavisindeki rolünü belirlemek amaçland .Hastalar ve yöntem: Çal maya en az 3 ayd r takip edilen ve/veyatekrarlayan efüzyonlu otitis media tan s ile izlenen, 1-14 ya aras 71 çocuk hastaal nd . Hastalar n ikayetleri sorguland , kulak burun boHaz ve sistemik muayeneleriyap ld . Bütün hastalara radyonüklid sintigrafi ve ayn zamanda bu hastalar n 12'sine24 saat pH monitorizasyonu yap ld . Hastalar reflü pozitif (I. grup) ve reflü negatif(II. grup) olmak üzere iki gruba ayr ld . I. gruba antireflü, II. gruba ise antibiyotiktedavisi verildi. lk 3 ay ayda bir kez, daha sonra üç ayda bir tekrar ikayetlersorguland , kulak burun boHaz muayenesi ve odyolojik testlerle kulaklardeHerlendirildi. Gruplar aras nda tedavi öncesi tespit edilen veriler ile tedavidensonra 3. ayda elde edilen veriler, nüks, maliyet ve cerrahiye gereksinimkar la t r ld .Bulgular: Hastalar n 37'si (%52,2) I. grupta, 34'ü (%47,8) ise II. grupta yerald . Gruplar aras nda ya , cinsiyet, ikayet süresi, tedavi ve takip süresi aç s ndanistatistiksel olarak anlaml fark yoktu (P>0,05) Tedavi sonras efüzyonlu otitismedia'da I. gruptaki hastalar n 26's nda (%70,3) ve II. gruptaki hastalar n ise24'ünde (%70,6) tam iyile me tespit edildi (P>0,05). I. gruptaki hastalar n 8'inde(%21,6) ortalama 6Â±4,1 ay sonra, II. gruptaki hastalar n ise 5'inde (%14) ortalama4,5Â±3,6 ay sonra efüzyonlu otitis media'n n tekrarlad H belirlendi (P>0,05).Tekrarlama sonras yeniden verilen tedaviyle I. gruptaki hastalarda istatistikselolarak anlaml oranda daha fazla iyile me vard (P<0,05). I. gruptaki hastalar n11'inde (%29,7), II. gruptaki hastalar n ise 10'unda (%29,4) efüzyonlu otitismedia'da hiç iyile me olmad H görüldü ve bu hastalara adenoidektomi veventilasyon tüpü tak ld (P>0,05).viiiSonuç: Gastroözefageal reflünün, efüzyonlu otitis media'l çocuklarda %52,2oran nda tespit edilmesi ve reflü olan hastalarda antireflü tedavi ile %70,2 iyile megörülmesi nedeniyle etyoloji ve tedavide rolü olduHu dü ünüldü. Ayr cagastroözefageal reflü hastal H n n EOM'n n tekrarlamas nda bir etken olabileceHigörüldü.Anahtar kelimeler: Çocuk, efüzyonlu otitis media, gastroözefageal reflühastal H , radyonüklid sintigrafi, 24 saat pH monitorizasyonuix

Abstract:
THE ROLE OF GASTROESOPHAGEAL REFLUXDISEASE IN ETIOLOGY AND TREATMENT OF OTITISMEDIA WITH EFFUSIONABSTRACTAim: This study aims to clarify the role of gastroesophageal reflux disease inotitis media with effusion in the pediatric age group.Patients and method: 71 children who have been diagnosed as recurrentotitis media with effusion and followed up at least for 3 months were included in thestudy. They were aged between 1 and 14 years. Radionuclide gastroesophagealscintigraphy were performed to all of the patients and 12 of them underwent pHmonitarization for 24 hours. The patients were divided into two groups as refluxpositive (group I), and reflux negative(group II). Antireflux treatment wasadministered to group I, and antibiotic treatment was administered to group II. In thefirst three months, once a month, and once in the following three months, thecomplaints were questioned and their ears were evaluated and audiologic tests weredone. The data including the relapse, cost and operation need were comparedbetween the group I and group II, before the treatment and in the third month afterthe treatment.Results: There were 37 patients (52.2 %) in group I, and 34 (47.8 %) ingroup II. There was no statistical difference between the groups from the point ofage, sex, duration of complaints, treatment and follow-up period (p>0.05). After thetreatment, 26 of the patients in group I (70.3 %), and 24 of the patients in group II(70.6 %) recovered completely (p>0.05). Otitis media with effusion recurred in 8patients in group I (21.6 %) after 6+4,1 months and in 5 patients in group II (14%)after 4,5+3 months(p>0,05). With a new course of treatment after the recurrence,there was a significant recovery in the patients in group I (p<0.05). In 11 of thepatients in group I (29.7 %) and in 10 of the patients in group II (29.4 %), there wasxno recovery. Adenoidectomy and ventilation tube insertions were done to thesepatients. (p>0.05).Conclusion: Gastroesophageal reflux disease have a role in etiology since itwas observed in 52 % of the children with otitis media with effusion, and it has anrole in the treatment since with the antireflux treatment, there was a 70.2 % recoveryin children. Besides, gastroesophageal reflux disease has something to do with therecurrence of the otitis media with effusion.Key words: Child, Otitis media with effusion, Gastroesophageal refluxdisease, Radionuclide scintigraphy, 24-hour pH monitoring.xi