DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20171521

A study on the effect of adenoidectomy with tonsillectomy in otitis media with effusion in children

Ajayan P. V., Divya Raj M. L., Anju Mariam Jacob

Abstract


Background: The aural symptoms attributed to adenoid hypertrophy are Eustachian tube block (ET) and otitis media with effusion (OME). It is thought that adenoid hypertrophy causes a block in air flow through the ET, thus creating a negative pressure in the middle ear leading to effusion which acts as a focus of infection. The role of hypertrophied tonsils in the aetiology of OME is controversial. Adenoid and tonsillar hypertrophy and associated inflammation continue to be a major problem in paediatric age group despite the advances in medicine. Otitis media with effusion is a treatable cause of deafness which may hamper the learning ability of a child. This study was undertaken to study the effect of adenoidectomy with tonsillectomy on established otitis media with effusion in children.

Methods: 35 children presenting to the department of ENT, Government Medical College, Thrissur, Kerala, India over one and a half years with features suggestive of secretory otitis media, tonsillar and adenoid hypertrophy who underwent adenoidectomy with tonsillectomy in Government Medical College, Thrissur, Kerala, India were included in the study. A predesigned questionnaire was prepared which included details on clinical symptoms, relevant investigations and preoperative and postoperative evaluation of hearing after 6 weeks and 3 months. Data collected was analyzed using paired t-test and chi square test to determine the improvement in hearing after 6 weeks and 3 months following surgery.

Results: Out of the 35 children included in the study, it was seen that 56% of cases, after 6 weeks showed complete resolution of OME which improved to 67% after 3 months. This was assessed by PTA and tympanometry. 33% showed partial improvement with Type C curve in tympanometry and improvement in PTA values.

Conclusions: All cases of OME associated with adenoid and tonsillar hypertrophy responded to our treatment with 67% showing complete cure of the condition. It can be assumed that, in the 33% partial responders there may be other factors like allergy, anatomical deformities, immunological which prevented the complete resolution of symptoms in OME. 


Keywords


Adenoidectomy, Otitis media with effusion, Tonsillectomy

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References


Scott-Brown WG. Paediatric Otolaryngology. In: Kerr AG, ed. Scott-Brown's Otolaryngology. 6th ed. London: London. 1997:6.

Brodsky L, Robin T, Cotton M, Charles M. Practical Pediatric otolaryngology. 1st ed. New York: Lippincott Raven; 1997.

Cengel S, Akyol MU. The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy. Int J Pediat Otorhinolaryngol. 2006;70(4):639-45.

Maw AR. Chronic otitis media with effusion (glue ear) and adenotonsillectomy: prospective randomised controlled study. Br Med J (Clin Res Ed). 1983;287(6405):1586-8.

Sinha V, Patel BH, Sinha S. Incidence of uncomplained secretory otitis media in patients undergoing adenotonsilectomy. Indian J Otolaryngol Head Neck Surg. 2005;57(2):110.

Marseglia GL, Poddighe D, Caimmi D, Marseglia A, Caimmi S, Ciprandi G, et al. Role of adenoids and adenoiditis in children with allergy and otitis media. Curr Allergy Asthma Rep. 2009;9(6):460-4.

Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. Am J Roentgenol. 1979;133(3):401-4.

Teele DW, Klein JO, Rosner B, Greater Boston Otitis Media Study Group. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989;160(1):83-94.

Ferreira AM, Clemente V, Gozal D, Gomes A, Pissarra C, César H, et al. Snoring in Portuguese primary school children. Pediatrics. 2000;106(5):e64.

Tos M, Larsen PL, Stangerup SE, Hvid G, Andreassen UK. Sequelae following secretory otitis and their progression. Acta Oto-Laryngologica. 1988;105(449):37-8.

Onusko ED. Tympanometry. Am Fam Phys. 2004;70(9):1713-20.

Fria TJ, Cantekin EI, Eichler JA. Hearing acuity of children with otitis media with effusion. Arch Otolaryngol. 1985;111(1):10-6.

Ishii T, Toriyama M, Suzuki JI. Histopathological study of otitis media with effusion. Ann Otol Rhinol Laryngol. 1980;89(3):83-6.

Sandooja D, Sachdeva OP, Gulati SP, Kakkar V, Sachdeva A. Effect of adeno-tonsillectomy on hearing threshold and middle ear pressure. Indian J Pediatr. 1995;62(5):583-5.

Howie VM, Ploussard JH, Sloyer J. The otitis-prone condition. Am J Dise Children. 1975;129(6):676-8.

Friel-Patti S, Finitzo T. Language learning in a prospective study of otitis media with effusion in the first two years of life. J Speech Language Hearing Res. 1990;33(1):188-94.

Roberts J, Hunter L, Gravel J, Rosenfeld R, Berman S, Haggard M, et al. Otitis media, hearing loss, and language learning: controversies and current research. J Develop Behavl Pediatr. 2004;25(2):110-22.

Rubin J. What the good language learner can teach us. TESOL quarterly. 1975:41-51.