The effects of adenoidectomy in cases of secretory otitis media in school going children

Abstract

Background and Objectives: Secretory Otitis media is one of the most common childhood diseases. It is the leading cause of hearing loss in children. Prolonged or fluctuating hearing impairment in early childhood may result in long-term consequences for speech and language development. The age at which incidence peaks for recurring middle ear effusions corresponds to the period of maximum lymphoid hyperplasia in the nasopharynx. Despite numerous studies on the prevention and treatment of SOM during the past decades, its management remains challenging and controversial. In this context, the study entitled a clinical study to determine the effects of adenoidectomy in cases of secretory otitis media in school going children was taken. Method: This study comprised 40 cases, who were aged 5-12 years and diagnosed as SOM with adenoid hypertrophy.  After detailed history and clinical examination, investigations such as pure tone audiogram, impedance audiometry, X ray nasopharynx and diagnostic nasal endoscopy were carried out to confirm the diagnosis. All patients were posted for adenoidectomy and when indication was present tonsillectomy was also done. They were followed up at 1^st, 3^rd and 6^th month for pure tone audiometry and impedance was done at 6^th month of surgery. Results: In this study, maximum number (50%) of cases belonged to 5-7 years age group, with slight male preponderance (55%) when compared to females (45%).   All patients had nasal obstruction and snoring and 82.5% had nasal discharge. Hard of hearing was common symptom of ear seen in 67.5% of cases with fullness in 25%. Tonsillitis and sinusitis were seen in 37.5% and 17.5% respectively. On otoscopy, dull, lustreless and amber coloured TM was seen most commonly in 75%, retraction in 50% and air bubbles in 12.5%. On pure tone audiometry 60% had 16-25dB and 30% had 26-40 dB hearing loss and average being 23.95dB. On impedance only 10% had peak preoperatively. Postoperatively, no peak/peak conversion was seen in 41.25 % of cases and mean A-B gap improvement at 1^st, 3^rd and 6^th month was 12dB, 12.2dB and 11.7dB respectively (p value is 0.0001,<5%) when compared to preoperative findings. Conclusion: Adenoidectomy in children having hypertrophied adenoids with SOM, not only relieves Eustachian tube obstruction but also removes source of infection. This leads to clearance of middle ear effusion and improvement in hearing postoperatively.

Key words: Secretory otitis media; Adenoidectomy; Pure tone audiometry; Impedance audiometry.