Basınç ve Sesle Tetiklenen Vertigo Perilenf Fistülü ve Süperior Semisirküler Kanal Dehisansının Klinik Yaklaşımı
Özet
Bu bölümde, basınç ve sesle tetiklenen vertigo nedenlerinden perilenfatik fistül (PLF) ve süperior semisirküler kanal dehisansı (SSKD) tanı ve tedavileri incelenmektedir. Dış kulak yolu basıncıyla gelişen vertigo/nistagmus "Hennebert belirtisi", yüksek sesle tetiklenen durum ise "Tullio fenomeni" olarak tanımlanır. PLF, iç kulak ile orta kulak arasındaki anormal sıvı geçişi olup sıklıkla barotravma veya kafa travması sonucu oluşur; dalgalı işitme kaybı ve vertigo ile seyreder. Kesin tanı orta kulak eksplorasyonu ve Cochlin-tomoprotein (CTP) veya beta-2 transferrin gibi biyokimyasal testlerle desteklenir. Tedavide aktivite kısıtlaması, ventilasyon tüpü veya cerrahi oklüzyon uygulanır. SSKD ise otik kapsülde oluşan "üçüncü pencere" mekanizmasıyla iletim tipi işitme kaybı, otofoni ve osilopsiye yol açar. Tanıda yüksek çözünürlüklü temporal BT ve VEMP (yanıt eşiklerinde düşme, amplitüt artışı) kritik önem taşır. Semptomatik hastalarda temel tedavi, orta kafa çukuru veya transmastoid yaklaşımla kanalın tıkanması veya yüzeyinin rekonstrüksiyonudur.
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