Follow-Up and Community Care of the Child With a Chronic Disease

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DOI :10.26650/B/CH32.2024.010.040   IUP :10.26650/B/CH32.2024.010.040    Full Text (PDF)

Follow-up and Community Care of the Child with Chronic Ear Disease

Mehmet Çelik

Early diagnosis of neonatal chronic hearing loss primarily prevents the emergence of irreversible changes in the auditory pathway and cortical areas and enables auditory rehabilitation. Thus, the child will be ensured to take place in society as a psychologically and socially healthy individual without affecting speech development. Hearing loss can be either conductive, sensorineural, or mixed type. Conductive hearing loss occurs in the outer and middle ear. Sensorineural losses are common in the cochlea, the neural pathways, and cortical regions, and congenital total hearing loss has a high prevalence in children. Its incidence is 1–3/1.000 in healthy infants delivered on schedule. In general, the most common cause of hearing loss in childhood is otitis media with effusion (OME), characterized by the accumulation of fluid in the middle ear region alone, without signs and symptoms of acute ear infection. OME often causes conductive hearing loss in children but can be easily overlooked in asymptomatic patients. However, symptomatic children rarely complain of hearing loss, thus leading to parental concern about the child’s hearing. Speech development may be delayed or reach a plateau, which may hinder the child’s school achievement. Some children may withdraw from society and demonstrate minimal social behavior. Clinically, OME is evaluated using otoscopy, tympanometry, and audiometry methods to first check for nasal and nasopharyngeal obstruction based on breathing through the mouth and nose. Otoscopy has diagnostic accuracy in approximately 78% of cases, with 95% specificity when performed by an experienced physician. Management of OME consists of active observation (wait and see), medical treatment, and surgical interventions. Herein, the current diagnosis, follow-up, and treatment methods of children with long-term hearing loss are reviewed. 


Keywords: Hearing loss, otitis media with effusion, hearing rehabilitation
DOI :10.26650/B/CH32.2024.010.040   IUP :10.26650/B/CH32.2024.010.040    Full Text (PDF)

Kroni̇k Kulak Sağlığı Sorunu Olan Çocuğun İzlemi̇ ve Toplumda Bakımı

Mehmet Çelik

Yenidoğan kronik işitme bozukluğunun erken teşhisi işitsel yolak ve kortikal alanlarda geriye dönüşsüz değişikliklerin ortaya çıkmasını önlemek ve bireyin işitsel rehabilitasyonunu sağlamak amacıyla öncelikli eylemlerdendir. Böylece konuşma gelişimi etkilenmeden, psikolojik ve sosyal açıdan sağlıklı bir birey olarak toplumda yer alınması sağlanacaktır. İşitme kayıpları iletim, sensörinöral ya da miks tip olarak karşımıza çıkmaktadır. İletim tipi işitme kayıpları dış ve orta kulak patolojilerine bağlı oluşmaktadır. Sensörinöral kayıplarda ise koklea ve sonrasındaki sinirsel yolak ve kortikal bölgelerle alakalı olup çocuklarda en sık doğumsal genel işitme kaybı şeklinde görülür. Sıklığı zamanında gerçekleşen sağlıklı doğumlarda 1-3/1.000 olarak saptanmıştır. Genel olarak çocukluk çağında en sık karşılaşılan işitme kaybı nedeni efüzyonlu otitis media olup akut kulak enfeksiyonunun belirti ve bulguları olmaksızın tek başına orta kulak bölgesinde sıvı birikmesini ifade eder. Sıklıkla çocuklarda iletim tipi işitme kaybına neden olur. Belirgin bir semptoma yol açmamış çocuklarda kolaylıkla gözden kaçabilmektedir. Semptomların olduğu durumlarda, çocuklar nadiren işitme kaybından şikâyet ederler. Daha yaygın olarak, çocuğun işitmesiyle ilgili ebeveynlerin endişesi vardır. Konuşma gelişimi gecikebilir veya bir platoya ulaşabilir. Okul başarısında bozulma olabilir. Bazı çocuklar toplumdan geri çekilebilir ve davranışlarda azalma gözlenebilir. Klinik olarak efüzyonlu otitis media otoskopi, timpanometri ve odyometri yöntemleri kullanılarak değerlendirilir. Muayenede ilk olarak burun ve nazofarenks tıkanıklığı açısından ağız ve burun solunumunun değerlendirilmesine dikkat edilir. Otoskopi, tecrübeli bir hekim tarafından yapıldığında %95 özgüllük ile vakaların yaklaşık %78’inde tanısaldır. Efüzyonlu otitis medianın yönetimi, aktif gözlem (bekle-gör), tıbbi tedavi ve cerrahi müdahalelerin çeşitli kombinasyonlarından oluşur. Bu bölümde uzun süreli işitme kaybı olan çocukların güncel tanı, takip ve tedavi yöntemlerinin literatür eşliğinde tartışılması amaçlanmaktadır.


Keywords: İşitme kaybı, effüzyonlu otitis media, işitme rehabilitasyonu

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