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Medizinpsychologische Aspekte bei der Behandlung kindlicher Tränenabflussstörungen

Elterliche Beurteilung eigenen und kindlichen Stresserlebens

Medical and psychological aspects of the treatment of connatal dacryostenosis

Parental evaluation of their own and their child’s stress

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An Erratum to this article was published on 08 July 2016

Zusammenfassung

Hintergrund

Die Sondierung und Überdruckspülung der ableitenden Tränenwege (TNW) bei konnataler Dakryostenose kann in Lokalanästhesie (LA) oder Allgemeinanästhesie (AA) durchgeführt werden. Dabei können durch Schmerzen und Ängste starke Stressempfindungen bei Eltern und behandelten Kindern entstehen.

Methodik

Mittels Fragebögen (n = 65) beurteilten die Eltern ihr eigenes Stressempfinden sowie das ihrer Kinder. Untersucht wurden Einfluss der Anästhesieform, Vertrauen in die ärztliche Behandlung, Therapieerfolg, Vorerfahrungen mit AA, Bildungsniveau der Eltern, Alter der Eltern und Kinder, Anzahl der Kinder und zeitlicher Abstand zur Behandlung auf das Stresserleben. Der Stress wurde auf einer Skala von 1 (kein Stress) bis 10 (maximaler Stress) bewertet.

Ergebnisse

Das Alter der Kinder betrug im Mittel 8,5 ± 7,42 Monate, jenes der Eltern 30,8 ± 6,17 Jahre. Das elterliche Stressempfinden (Mittelwert (M) = 7,15) unter der Behandlung in LA wurde übereinstimmend stark mit dem ihrer Kinder (M = 7,82) eingeschätzt. Die Eltern beurteilten den kindlichen Stress bei einer Behandlung in LA (n = 47; M = 7,34) signifikant höher als bei einer Behandlung in AA (n = 18; M = 6,06; p < 0,05). Eltern mit 2 oder mehr Kindern beurteilten ihren eigenen Stress signifikant niedriger als Eltern mit einem Kind. Eltern mit Vorerfahrungen mit AA zeigten ein signifikant höheres Stressniveau. Alle anderen Faktoren hatten keinen signifikanten Einfluss auf die Stressbewertung.

Schlussfolgerung

Ein möglicher Einflussfaktor für die als höher bewertete Stressbelastung in LA ist die Wahrnehmung kindlicher Reaktionen (z. B. Weinen) durch die Eltern während der Behandlung. Dennoch zeigte sich eine vergleichsweise höhere Akzeptanz der LA im Vergleich zur AA, v. a. bei Eltern mit AA-Vorerfahrungen.

Abstract

Background

Lacrimal probing and syringing for connatal dacryostenosis can be performed under local (LA) and general anesthesia (GA). In cases of invasive medical procedures, pain and anxiety can be distressing for children and their parents.

Materials and methods

Using questionnaires (n = 65), parents were asked to evaluate their own stress and that of their child during lacrimal probing and syringing. Analyzing different subgroups, the impact of the kind of anesthesia (LA vs. GA), trust in medical treatment, therapeutic success, prior experiences with GA, parental educational level, age of parents and children, number of children, and time between the intervention and the interview on the stress was examined. Stress level was evaluated on a scale from 1 (no stress) to 10 (maximal stress).

Results

Mean children’s age was 8.5 ± 7.42 months. Mean age of the parents was 30.8 ± 6.17 years. Treating children under LA, parents reported moderate to severe stress levels for themselves (mean, M = 7.15) and for their children (M = 7.82). Children’s stress levels were significantly higher when the treatment was performed under LA (n = 47; M = 7.34) in comparison to GA (n = 18; M = 6.06; p < 0.05). Parents having two or more children reported significantly lower stress levels than those with only one child. Furthermore, prior experiences with GA led to significantly higher parental stress levels when their children were treated under GA. Other factors did not show any impact on parent’s and children’s stress levels.

Conclusions

Parents might have been influenced by hearing the children’s reaction (e. g., crying) during the intervention under LA. Nevertheless, parents had a higher acceptance of this type of intervention (LA) in comparison to GA. This effect was even stronger among parents with prior experience of GA.

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Augenheilkunde, Martin-Luther-Universität Halle-Wittenberg, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland

    J. Heichel, F. Bachner, H.-G. Struck & T. Bredehorn-Mayr

  2. Klinik für Neurologie, Krankenhaus Martha-Maria Halle-Dölau GmbH, Halle (Saale), Deutschland

    F. Bachner

  3. Institut für Psychologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland

    G. Hübner

  4. MSH Medical School Hamburg, Hamburg, Deutschland

    G. Hübner

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  1. J. Heichel
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  4. H.-G. Struck
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  5. T. Bredehorn-Mayr
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Correspondence to J. Heichel.

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Interessenkonflikt

J. Heichel, F. Bachner, G. Hübner, H.-G. Struck und T. Bredehorn-Mayr geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag enthält Studien an Menschen. Eine Zustimmung der Ethikkommission war nicht notwendig. Zu allen Patienten liegt eine Einverständniserklärung vor.

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Dieser Beitrag ist als eine Originalarbeit anzusehen und aus formalen Gründen im Leitthema dieser Ausgabe eingeordnet.

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Heichel, J., Bachner, F., Hübner, G. et al. Medizinpsychologische Aspekte bei der Behandlung kindlicher Tränenabflussstörungen. HNO 64, 376–385 (2016). https://doi.org/10.1007/s00106-016-0167-1

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