Ukwakhiwa Kabusha Kwezakhiwo Zendlebe Ephakathi Nangaphandle

Ukwakhiwa kabusha Kwezindlebe ( Tympanoplasty ) Ukuhlinzwa e-Hyderabad, India

Ukukhula kwezindlebe okungavamile kungase kubangele ukuhlukumezeka noma izifo. Nakuba okunye okudidayo kungase kungadingi ukungenelela futhi kungase kuzilungise ngokwakho (ngokwesibonelo, okubangelwa ukuma okungavamile ngaphakathi kwesibeletho), okunye okungavamile kungase kudingeke kulungiswe ngokuhlinzwa njengoba lokho okungahambi kahle kwesakhiwo kungase kuvimbe indlela yokuphila evamile kumuntu. Ukwelashwa kwendlebe okungahlinzeki, okufana nesikhunta sendlebe, ngokuvamile kusetshenziswa ngemva kokuzalwa komntwana njengoba ngaleso sikhathi uqwanga lwendlebe luthambile futhi luyabumbeka. Ukubumba indlebe yangaphandle okungahlinzeki kuthathwa njengesidingo ngokukhubazeka kwendlebe yokuzalwa enokukhubazeka kokuzwa okusebenzayo.

Ukuhlinzwa kokuvuselela indlebe kwangaphandle kuhilela amazinga ahlukahlukene okuhlinzwa futhi kungase kwenziwe ukuze kulungiswe ukungabikho kokuzalwa kwendlebe, ezinye izimo zezokwelapha ezifana ne-microtia kanye anotia, nokulungisa indlebe yangaphandle ekhubazekile edalwe ngenxa yokulimala noma ukulimala. Ukuhlinzwa kokwakhiwa kabusha kwendlebe ephakathi kwenzelwe i-otitis media (COM), engahlukaniswa ngezindlebe ezingezona i-cholesteatomatous nezindlebe ze-cholesteatomatous. Izindlebe ezingezona ze-cholesteatoma zifaneleka kakhulu ukuhlinzwa kwendlebe ephakathi kabusha (ukwakhiwa kabusha kwe-tympanic). Ngokuyisisekelo, ukwakhiwa kabusha kwe-tympanic kuhlanganisa ukulungiswa kwesici se-membrane ye-tympanic noma i-myringoplasty kanye nokulungiswa kwesici se-ossicular noma i-ossiculoplasty.

I-Otoplasty ukuhlinzwa kwezimonyo okwenziwa ikakhulukazi ngenxa yezizathu zobuhle kodwa ngokuvamile kuyakha kabusha ngokwemvelo. I-Tympanoplasty ingenye inqubo yokuhlinzwa yokulungisa nokuvuselela indlebe ephakathi (i-tympanic membrane) ukusiza ukubuyisela ukuzwa okuvamile esigulini. Le nqubo ingase futhi ihilele ukulungiswa noma ukwakhiwa kabusha kwamathambo amancane ngemuva kolwelwesi lwe-tympanic (ama-eardrums) uma kudingeka. Kokubili amathambo endlebe ephakathi nendawo ayadingeka ukuze kusebenze ndawonye ukuze kusizwe ukuzwa okuvamile kubantu.

Ezibhedlela ze-CARE, ithimba lethu le-ENT ehlukahlukene kanye nochwepheshe bokuhlinza izimonyo bahlinzeka ngokuxilonga nokwelashwa okuphelele kusetshenziswa imishini yesimanje efakwe ubuchwepheshe bamuva futhi ilandele izindinganiso zamazwe ngamazwe zezivumelwano zokuhlinzeka ngokunakekelwa kokuphela kokuhlinzwa kweziguli ezilandelelwa njalo kanye nomhlahlandlela ofanele ukuze uqedele ukululama kwezimo ezithile zempilo eziqondile nezijwayelekile.

Yiziphi izimo zendlebe ezidinga ukuhlinzwa?

Indlebe yangaphandle

I-tympanoplasty yendlebe yangaphandle inconywa kulezi zimo ezilandelayo:

• I-eardrum ephukile (eboshiwe),

• I-Sunken eardrum (i-atelectatic),

• I-anomalies ye-eardrum ebangela ukungezwa.

Ukungajwayelekile kwe-eardrum namathambo endlebe ephakathi kungenzeka ngokulimala, i-otitis media engapheli, ukukhubazeka kokuzalwa, noma izimo zendlebe ezingapheli ezifana ne-cholesteatoma.

Indlebe ephakathi

Kungase kube nezimo eziningana ezidinga i-otoplasty yolwelwesi lwe-tympanic lwendlebe ephakathi, ikakhulukazi i-anomalies yokuzalwa. Ezinye izimo zezokwelapha ezidinga i-otoplasty zibalwe ngale ndlela elandelayo:

• Indlebe egqamile noma ephumile: Izindlebe ezivelele ukungavamile kokuzalwa lapho izindlebe zivame ukuvela kude nekhanda ngaphandle kokudala ukusilela ekusebenzeni. Lesi simo kungenzeka sakhiwe ngesikhathi sokuzalwa ngenxa yokungakheki kahle kwe-antihelix, i-concha ekhule ngokweqile noma ejule kakhulu, noma inhlanganisela yalezi zimo. I-otoplasty esimweni esinjalo ingenziwa ngenxa yezizathu zobuhle.

• I-Microtia: I-Microtia ichazwa njengokukhubazeka kwendlebe okungaphelele okuvame ukuhlotshaniswa ne-congenital aural atresia. Lokhu kungase kwenzeke njengesifo esisodwa, njengengxenye ye-hemifacial microsomia complex, noma njengengxenye ye-congenital complex.

• Anotia: Anotia ukungabikho ngokuphelele kwendlebe yangaphandle nomsele wokuzwa. Lokhu kungase kubhekwe njengohlobo olunzima lwe-microtia.

• I-trauma noma i-neoplasm: Ukuhlukumezeka ezindlebeni kungase kubangelwe ukulimala noma izingozi. Ukuchayeka elangeni okungenakugwenywa komphetho wendlebe we-helical kunomthelela ekwakhiweni kwe-neoplasm yesikhumba futhi ukususwa ngokulawulwa kwe-margin okunembile kungase kunconywe. Ukwakhiwa kabusha ngokuvamile kuyadingeka ukuze kuthuthukiswe ukubukeka nokusebenza komzimba. 

• Ukufakelwa kwe-Cochlear: Ukulahlekelwa kwezindlebe ze-Sensorineural kungase kwenzeke ngenxa yesici sokuzalwa, isifo, noma ukuhlukumezeka kwendlebe yangaphakathi futhi kungase kubangele ukulahlekelwa ukuzwa okuthi lapho kuba okujulile, insiza yokuzwa ingase ingabi indlela yokwelapha ephumelelayo. Ukufakelwa kwe-cochlear kungasiza ukukhulisa amandla okuzwa eziguli.

Yiziphi izindlela zokwelapha ezitholakalayo?

Ukulungisa ukuhlinzwa ngokuvamile kwenziwa ngezinjongo zezimonyo kanye nezizathu zokusebenza. Ukuze kulungiswe futhi kwakhiwe kabusha ukukhubazeka kwezindlebe zangaphandle, i-tympanoplasty ingenziwa, futhi ukwakhiwa kabusha kwendlebe engavamile noma ukulungiswa, i-otoplasty ingenziwa. Zombili izinqubo zokuhlinza zenziwa odokotela abahlinzayo abangochwepheshe be-ENT abaqeqeshwe kahle, abagunyazwe yibhodi kanye nodokotela abahlinzayo bezimonyo. 

Ukwelashwa

Kokubili i-tympanoplasty kanye ne-otoplasty kwenziwa ngaphansi kwe-anesthesia ejwayelekile elawulwa odokotela bethu abanolwazi oluphezulu kanye nodokotela bethu abahlinzayo be-ENT kanye nodokotela abahlinzayo bezimonyo. 

• I-Tympanoplasty: Ukusikwa kokuhlinzwa kwenziwa ngemuva kwendlebe, kuyisa indlebe phambili okuveza isigubhu sendlebe. I-eardrum iphakanyiswa ukuze ikwazi ukuhlola indlebe ephakathi ngokucophelela. Uma kwenzeka kunembobo ku-eardrum, ingahlanzwa futhi indawo engavamile ingase inqunywe. Ukuxhunyelelwa kwesikhumba kungenziwa endaweni yembobo ye-eardrum ukuze ukwazi ukwakha i-eardrum entsha engaguquki kuyo yonke imbobo. Uma kudingekile, ukwakhiwa kabusha kwamathambo endlebe ephakathi kungase kwenziwe kanye nale nqubo noma ukususwa kwe-cholesteatoma kungase kwenziwe ngalesi sikhathi.
• I-Otoplasty: Umgomo we-otoplasty uwukwakha kabusha indlebe ejwayele ukubonakala nokubuyiselwa komsebenzi. Ku-otoplasty, i-incision ingase yenziwe ngemuva kwendlebe ukuze kukhishwe ingxenye eyodwa noma ngaphezulu. Lokhu kungase kuhlanganise ukususwa kwezibazi, izicubu ezikhubazekile kanye nokufakwa kwe-costal cartilage. Izinga legolide lokwelapha ukukhubazeka kwe-microtia kanye ne- anotia i-autologous rib cartilage grafting. 
• Lokubuyisela: Lokhu kuhlinzwa kuvame ukudinga ukulala ubusuku bonke esibhedlela futhi isiguli singase siqashwe ngeso elibukhali odokotela. I-Ear Drops ingase inqunywe ngemva kokukhishwa. Ama-aphoyintimenti okulandelela angase anconywe ukuze kuqinisekiswe ukululama okufanele, futhi uhlole indawo yokusebenza ukuze ukhuthaze ukuphulukiswa okusheshayo nokuthuthukisa inqubekelaphambili ekubukekeni okusha.

Izingozi

Ukwakhiwa kabusha kwezindlebe, njenganoma iyiphi inqubo enkulu yokuhlinzwa, kuza nezingozi ezingokwemvelo, okuhlanganisa amandla okopha, ukutheleleka, kanye nokusabela okungekuhle ekubulaweni kwezinzwa.

Izingozi ezengeziwe ezihlobene nokwakhiwa kabusha kwezindlebe zihlanganisa:

• Ukukhwabanisa: Nakuba izibazi ezibangelwa ukuhlinzwa zihlala unomphela, zivame ukufihlwa ngemuva kwendlebe noma ngaphakathi kwama-creases endlebeni.
• I-Scar Contraction: Izibazi zokuhlinza zinamandla okuncipha futhi ziqiniswe phakathi nenqubo yokuphola. Lokhu kufinyela kungase kuholele ekushintsheni kokuma kwendlebe noma ukulimala kwesikhumba esizungeze indlebe.
• Ukuqhekeka Kwesikhumba: Isikhumba esisetshenziselwa ukuvala uhlaka lwendlebe singase sibhidlize ngemva kokuhlinzwa, siveze okufakwayo noma uqwanga olungaphansi. Ezimweni ezinjalo, kungase kudingeke ukuhlinzwa okwengeziwe.
• Ukulimala Endaweni Yokuxhunyelelwa Kwesikhumba: Uma isikhumba sivunwa kwenye ingxenye yomzimba ukuze kwakhiwe i-flap yokuvala uhlaka lwendlebe (olwaziwa ngokuthi i-skin graft), izibazi zingase zikhule endaweni yokunikela. Isibonelo, uma isikhumba sikhishwe ekhanda, kungase kube nengozi yokuthi izinwele zingakhuli kabusha kuleyo ndawo.

Ongakulindela

Ukwakhiwa kabusha kwendlebe ngokuvamile kwenziwa esibhedlela noma umtholampilo wokuhlinza iziguli zangaphandle, ngokuvamile ngaphansi kwe-anesthesia evamile ukuze kuqinisekiswe ukuthi isiguli sisesimweni esifana nokulala futhi asizwe ubuhlungu ngesikhathi sokuhlinzwa.

Ngesikhathi Senqubo:

Ukwakhiwa kabusha nge-rib cartilage- Kunezindlela ezahlukahlukene zokuhlinzwa kokwakhiwa kabusha kwezindlebe. Enye indlela evamile ukwakhiwa kabusha kwe-autologous, ikakhulukazi ezinganeni ezinezimo zezindlebe zokuzalwa. Le nqubo, ngokuvamile eyenziwa phakathi kweminyaka engu-6 neyi-10, ihilela ukuhlinzwa oku-2 kuya koku-4. Izinyathelo zihlanganisa:

• Ukuvuna uqwanga ezimbanjeni ukwakha uhlaka olufana nendlebe.
• Ukubeka uhlaka ngaphansi kwesikhumba endaweni yendlebe.
• Ukuphakamisa indlebe kude nekhanda.
• Ukulolonga isikhumba kusuka kwenye ingxenye yomzimba (njengesikhumba sekhanda, enye indlebe, igroin, noma i-collarbone) phezu kohlaka lwendlebe ukuze kuzuzwe ukubukeka kwemvelo.

Ukwakhiwa kabusha ngokufakelwa- Enye indlela ihilela ukwakhiwa kabusha kusetshenziswa ukufakelwa kwezokwelapha kohlaka lwendlebe, ukugwema ukusetshenziswa kwe-rib cartilage. Kule nqubo, udokotela ohlinzayo uqinisa ukufakelwa endaweni yendlebe, emboza nge-flap yesikhumba eceleni kwekhanda. Isikhumba esivela kwesinye isitho somzimba sisetshenziselwa ukuvala indlebe entsha. Ngokuvamile, ukwakhiwa kabusha ngokufakelwa kudinga ukuhlinzwa okukodwa kuphela, futhi izingane ezineminyaka emi-3 zingase zifanelekele le nketho.

Ukubekwa kwendlebe yokwenziwa- Ezimweni lapho izicubu zendlebe zonakaliswe kakhulu (isb, ukusha), ingxenye enkulu yendlebe ilahlekile ngenxa yokuhlinzwa komdlavuza, noma eminye imizamo yokuvuselela ihlulekile, ukubekwa kwendlebe yokwenziwa kungase kucatshangelwe. Lokhu kuhilela ukususa ingxenye esele yendlebe nokunamathisela ngokuhlinzwa i-prosthesis ethanjeni endaweni yendlebe. Le ndlela isetshenziswa kakhulu kubantu abadala kunasezinganeni.

Ngemuva kwenqubo

Ukuthola kabusha kulandela ukwakhiwa kabusha kwendlebe kuyehluka kuye ngohlobo lokuhlinzwa okwenziwe. Ezinye izinqubo zingase zidinge ukuba silaliswe esibhedlela, kuyilapho ezinye zivumela isiguli ukuba sibuyele ekhaya ngalo lolo suku.

Ngemuva kokuhlinzwa, ungathola:

• Ubuhlungu
• Ukuvuvuka
• ukopha
• Itching

Landela uhlelo olunqunyiwe lokulawula ubuhlungu olunikezwa umhlinzeki wakho wokunakekelwa kwezempilo. Uma ubuhlungu buqhubeka noma buba nzima ngemithi, thintana nomhlinzeki wakho wezempilo ngokushesha.

Xhumana nelungu lethimba lakho lezempilo ukuze uthole imiyalelo yokunakekela indlebe yakho ngemva kokuhlinzwa. Kungase kudingeke ukuthi uvale indlebe yakho izinsuku ezimbalwa.

Gwema ukulala eceleni lapho ukwakhiwa kabusha kwendlebe kwenzeke khona futhi ugweme ukuhlikihla noma ukufaka ingcindezi endlebeni. Cabangela ukugqoka amahembe anezinkinobho noma lawo anamakholola axegayo.

Xoxa nomhlinzeki wakho wokunakekelwa kwezempilo lapho usungaqala kabusha imisebenzi yakho yansuku zonke, okuhlanganisa ukugeza nokuzikhandla ngokomzimba. Ukugadwa eduze kubalulekile ezinganeni ezincane ezilungiswa kabusha izindlebe, njengoba ukudlala kabi noma umsebenzi onzima kungaba yingozi endlebeni epholileyo.

Ukunakekelwa kokulandelela okuqhubekayo kubalulekile ngemva kokwakhiwa kabusha kwendlebe. Xhumana nomhlinzeki wakho wokunakekelwa kwezempilo mayelana nezikhathi ezidingekayo zangemuva kokuhlinzwa.

Imiphumela

Ukuphulukiswa okuphelele ngemva kokwakhiwa kabusha kwezindlebe kungase kuthathe isikhathi esingangezinyanga ezintathu. Uma unganelisekile ngemiphumela, cabanga ukuxoxa ngenketho yokuhlinzwa okwengeziwe nodokotela wakho ohlinzayo ukuze uthuthukise ukubukeka kwendlebe yakho.