Publication:

Role of adenoid hypertrophy in causation of chronic middle ear effusion

Abstract:Background: Hearing  plays  a  valid  role  in  speech  development  in  children. Otitis media with effusion is one among the commonest causes of hearing loss in children especially below 12 years. It is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infectionMethods: A prospective study was carried out in Lourdes Hospital, Kochi, over a period of 1 year from January 2013 to December 2013. Thirty patients with chronic middle ear effusion  below the age of 12 years were selected for the study.

Results of the 30 patients  59.5% of patients were in the age group of 5-7 years of age, 16.6 % of patients were in the age group of 9-11 years of age .13.3%  of patients  each were in  the age group of 3-5 years and 7-9 years of age.Among  the 30 patients ,60% were male children and 40% patients were female children.Among the 30 patients , 40% of them had grade 3 adenoid hypertrophy ,33.3% of them had grade 2 adenoid  hypertrophy and  30% of them had grade 4 adenoid hypertrophy and none had grade 1 adenoids. majority of them had grade 3 adenoid hypertrophy by endoscopic assessment.Among  the 30 patients ,66.6 % of them had eustachian tube blockade by the adenoid mass and  33.4% of  them didn’t have eustachian tube blockade.  100% of them  with eustachian tube blockade found to have fluid on doing myringotomy  and  there was  20% of chance of absence of  fluid ,if there is absence of  eustachian tube blockade.            Significant association was found between  type B tympanogram and presence of fluid on myringotomy .92.5% of patients with type B tympanogram had fluid on myringotomy . 57.1 % of patients with type C tympanogram  had fluid on doing myringotomy.There were 2 patients with grade 4 adenoid hypertrophy ,without eustachian tube blockade with  bilateral type C tympanogram and  there  was  bilateral dry tap on myringotomy. This reveals that type B tympanogram  and  eustachian tube blockade  better predictor of  otitis media with effusion   than grade of adenoid hypertrophy.

Conclusion The present  study  showed that  chronic middle ear effusion was found to be most common  in the age group of  3-5  years of age group and  relatively common in the male children. Tympanogram type B was found to be  strongly associated with fluid on myringotomy .All the children with chronic middle ear effusion in the study group were found to have  ,grade 3 grade 2,and grade 4  adenoid hypertrophy in the  descending order of frequency.Grade 3 adenoid hypertrophy was present in majority of  the children in the study group .Lateral  adenoid hypertrophy ,abutting on the nasopharyngeal orifice of Eustachian tube was present in majority of children. Eustachian tube obstruction was found to be strongly  associated with  fluid on myringotomy and grommet insertion