Iibhubhu zendlebe zivame ukuphendulwa njengesisombululo sokuqhubeka komkhuhlane ezindlebeni kwiintsholongwane zendlebe kuba i-buildup yamanzi ingabangela ukulahlekelwa kwindlebe. Nangona kunjalo, kukho imibuzo malunga nokusebenza kwamatope. Ukongeza, ii-tubes zendlebe zinobungozi bokukhangela, kuquka umngcipheko we-methacillin-resistant staphylococcus aureus (MRSA), onokumelana nemithi eminingi ye-antibiotics.
Ixesha lokusebenzisa iiThubhu zeNtloko
Kutheni iindlebe ze-tubes (i-tympanostomy tubes) zifuna ukuba ziqale? Umntwana omncinci unethubhe emfutshane ye-eustachian, eyenza ukuba akwazi ukuthintela izifo. Le bhubhe ye-eustachian ayidluli kude kube neminyaka emithathu okanye emine.
I-American Academy ye-Pediatrics inezikhokelo ekulawuleni izifo zentsholongwane yabantwana. Izifo zentloko zisoloko zixazulula ngokuzimeleyo ezinyangeni ezimbalwa. I-Academy icebisa ukuba umntwana ophethe i-otitis media nge-effusion (OME, ukusuleleka indlebe kunye ne-ear ear-middle ear fluid) kwiinyanga ezintathu okanye ukuvavanya ukulahlekelwa kwindlebe.
I-Academy inezincomo malunga nokuba yintoni enokuyenza ngokubhekisele ekubandezelekeni kwelahleko yokuvalelwa ngenxa ye-OME. Emva koko, ukuba ukulahlekelwa kwindlebe kunkulu okanye kulingana nama-decibel angama-40 (ngokulinganayo okanye ngaphezulu) kufunyaniswa, ukuhlinzwa (i-tubes ear) kuyanconywa kuba ukulahlekelwa kwindlebe kweso nqanaba okanye ngaphezulu kukwazi ukuthintela "intetho, ulwimi, nokusebenza kwezemfundo." Ngenxa yokulahlekelwa kweentengo ze-decibel ezingama-21 ukuya kwe-39, i-Academy icebisa ukujongana nokulahleka kweendlebe kuba ukulahlekelwa kwindlebe ephantsi kuyaziwa ngokuba nefuthe.
Xa ukuphulaphula kuyinto eqhelekileyo kodwa i-OME iqhubeka, iphinda iphinde iphendule iimvavanyo zentlanganiso emva kweenyanga ezintathu ukuya ezintandathu kamva.
Impumelelo
Ziphumelele kangakanani iimvalo zendlebe, kwaye zinyanga ezintathu zanele ngokwaneleyo ukuba zilinde ngaphambi kokuba ufumane iibhubhu? Ucwaningo, olukhankanywe kwiNgcaciso yeMpilo yabantwana , lwenziwe ngo-1991 kwabantwana abangama-429 abangaphantsi kweminyaka emithathu abafumana iibhubhu ngokukhawuleza, okanye emva kweenyanga ezilisithoba.
Olu pho nonongo luhlolisise ukuphuhliswa kwabantwana kwiminyaka emithathu, emine, nemithandathu kwaye ayifumani nantlukwano ekuphuhlisweni kwabo. Uphando olulandelayo luyenziwe xa abantwana bebaneminyaka elinesithoba ukuya kweyodwa ubudala, kwaye kwakhona, akukho mahluko afunyenwe kwiimilinganiselo ezingama-48 zophuhliso, kuquka iimvavanyo zokuhlola. Ababhali bolu cwaningo baphetha ukuba esikhundleni sokufumana indlebe ze-tubes emva kweenyanga ezintathu zentsholongwane eqhubekayo, kungcono ukuba ulinde kwaye ubukele ubuncinane kwiinyanga ezintandathu kwiindlebe zombini, kwaye ubuncinane neenyanga ezilisithoba kwindlebe enye.
Ucwaningo olulinganayo, oluxelwe kwi- Archives of Disease ebuntwaneni , lwenziwa ngabantwana abangama-395 abangaphantsi kweminyaka emithathu abanamalungu aphakathi kweendlebe eziphakathi kweentsuku ezingama-90 kwiindlebe zombini, okanye ubuncinane iintsuku ezili-135 kwindlebe enye. La bantwana bafumana ama-tubes indlebe ngokukhawuleza okanye ukuya kwiinyanga ezilisithoba emva koko. Bahlolwe kwiminyaka emithandathu kwiminyaka yokuphuhliswa phakathi kweqela "elikhawulezayo" kunye neqela "elilibazisekileyo", kwaye akukho namnye afunyenweyo.
Mngcipheko
Kanye njengawo nawuphi na uphando, i-tubes indlebe inxulumene nobungozi bentsholongwane, kuquka umngcipheko we-MRSA. Amaziko okuLawula nokuVikela (i-CDC) ichaza isifo socwangco olusakhulayo njengento eyenzeka ngaphakathi komnyaka wokuba unomzimba wasemzini, njengama-tubes endlebe, onyathelwe.
Kwenzeka kaninzi i-MRSA emva kokufakwa kwetayipi yeendlebe? Kubonakala ukuba akunjalo. Ingxelo ka-Disemba 2000 ye- Otolaryngology Head & Neck Surgery ichaza ukuba ukususela ngoDisemba 1998 ukuya kuJanuwari 2000, abantwana abasi-8 abafumana i-tubes ear ear developed MRSA. Ababhali bathi le nto yayiyi-"% yeziganeko ze-0.2%" kwi-MRSA, kodwa ayizange ibonise ukuba inani labantwana abafumene indlebe ye-tubes. Nangona kunjalo, abalobi bathi le nto yayiyindawo ephantsi kakhulu ye-MRSA.
Ukongezelela, ngokusekelwe kwinqaku ebonakalayo kwiphepha le-Agasti ka-2009 ye- Journal of Otolaryngology-Head & Neck Surgery , i-MRSA ayibonakali yinto eqhelekileyo kwiinkcubeko zezifo zentloko nokuba ngaba ayikho i-tubes ear.
Uphando olukhulu lwamaqela angaphezu kwama-400 avela kwi-2002 ukuya ku-2006 yaboniswa ukuba i-MRSA ikhona kwi-38 kuphela (8.5%) yamasiko endlebe. Ukongezelela, ukuphononongwa kwezifundo ezidlulileyo kwafika kwi-MRSA kwi-7% kuphela yeenkcubeko zezifo zentloko.
Kwakhona kunokwenzeka, njengoko kucetyiswa yi -Journal of Laryngology ne-Otology , ukuba uhlobo lwezinto ezisetyenziselwa iipipi zendlebe zingenza umehluko. Uphononongo olulinganisa ezintathu lubeka nganye yee-tubes eziphethwe nge-vancomycin, i-silver oxide ene-tubic silicone tubes kunye ne-tubrostomy tubes. (Ezi zigawuli azizange zifakwe kuzo naziphi na izigulane.) Abaphandi bahlolisise ukubunjwa kwe-MRSA biofilm, kwaye bafumanisa ukuba iibhubhu ezivutha nge-vancomycin "zazingenanto" ze-MRSA biofilm. Iziphumo zolu pho nonongo zixhasa imbono ye-tube ear material ibe yinto, kodwa ayizange iphindwe ngobomi bokwenene.
Ukukhathazeka kwabazali nge-MRSA kwiNtloko
Akukho bungqina obuxhasa inkxaso yokuba i-ear ear tubes ibangele i- MRSA . Enyanisweni, inokuthi ibe khona phambi kokufakwa kwee-tubes indlebe ngenxa yokuba i-MRSA ifunyenwe kubini nakwiibhedlele. Nangona kunjalo, i-MRSA kwindlebe kubonakala kunzima ukuyichitha.
Ngako-ke i-MRSA ingayiphathwa ngempumelelo njani endlebeni? Enye ingxelo ka-2005 kwi- Archives Of Otolaryngology Head & Neck Surgery yathi abantwana abathandathu abane-MRSA endlebeni abazange baphendule kwi-antibiotic yomlomo. Zonke ezithandathu zaphathwa ngempumelelo nge-trimethoprim-sulfamethoxazole yomlomo kunye neendlebe (gentamicin sulfate okanye i-polymyxin B sulfate-neomycin sulfate-hydrocortisone [Cortisporin]). Uninzi lwe-MRSA lufunyenwe ukuba lube ne-trimethoprim-sulfamethoxazole.
> Imithombo:
> Isikhokelo seKliniki yokuSebenza. I-Otitis Media nge-Effusion. American Academy Of Pediatrics.Pediatrics Vol. 113 Ngo-Meyi 2004, iphe. 1412-1429.
> "Yenza iiphubhu zendlebe ebantwaneni abancinci zithuthukisa intuthuko yazo kamva?" Isaziso sempilo yabantwana ngoFebruwari 2007: 3.
> Imiphumo ye-tympanostomy ene-vancomycin yengubo ye-methicillin engamelana ne-staphylococcus aureus i-biofilm eyenziwe: ukufunda kwi-vitro. Umbhalo weLaryngology & Otology (2010), 124: 594-598
> Imibuzo ebuzwa rhoqo. Ukukhulelwa kweSayithi yokuThengisa (SSI).
> I-Journal Watch. IiNgxelo zeZifo ebuntwaneni. 2006 uEpreli; 91 (4): 371-372.
> IMethicillin-Resistant Staphylococcus aureus I-orrhah Emva kweTympanostomy Tube Placement. Ukuxhalabisa. I-Archives Of Otolaryngology Inhloko kunye Nokunyuka Kwethambo Vol 126, kuMatshi 2000.
> Ngokubhekiselele kuPhuhliso lweeNkcazo ezisekelwe kwiNgqungquthela yoLawulo lwe-Methicillin-Resistant Staphylococcus aureus Otitis. I-Journal ye-Otolaryngology-Intloko kunye nokuPhenywa kweNeck, Vol 38, No-4 (Agasti), 2009: iphe 483-494.
> I-Trimethoprim-sulfamethoxazole kunye nee-antibiotics ezinjengeengqungquthela njengonyango lwe-otitis media kunye ne-otorrhea ebangelwa yi-sthifillin-resistant Staphylococcus aureus ebantwaneni. I-Archives Of Otolaryngology Inhloko kunye Nokunyuka Kwezinwele 2005 Sep; 131 (9): 782-4.