MEDICAL VERSUS SURGICAL MANAGEMENT OF OTITIS MEDIA WITH EFFUSION IN CHILDREN
Abstract
Background: Otitis media with effusion (OME) is a leading cause of hearing difficulty in children.OME must be detected early and managed properly to prevent hearing and speech impairment inchildren. This study was aimed to compare results of medical and surgical treatments in terms ofhearing improvement, recurrence of Middle Ear Effusion (MEE), time to offer surgical intervention.Methods: The study was conducted from June 2008 to December 2011. A performa was used tocollect data. Every child having hearing difficulty was examined with pneumatic otoscope for fluidlevel and tympanic membrane mobility. These children were investigated with pure tone audiometryfor level of hearing loss and tympanometry to confirm the middle ear effusion. X-Ray nasopharynxlateral view was taken to see if there were adenoids. All patients were treated conservatively in the firstphase. Those not responding to conservative treatment were treated with myringotomy andadenoidectomy with or without ventilation tubes. Patients were followed-up for up to 36 months.Results: Middle ear effusion cleared in 80 (71.5%) out of 112 ears. No improvement was noted in 32ears for 9 months. Resistant and recurrent cases were managed with adenoidectomy and myringotomyalone or with insertion of ventilation tubes (VT). Recurrence was noted more common withmyringotomy alone than with ventilation tubes. Medical treatment failed in 32 ears. MEE recurred in 9ears. VT was put in 41 ears. The hearing level improved with VT by 10–15 dB after first 3 months.Conclusion: All children with OME should be treated conservatively. It is cost effective and relievesMEE in about 70% of patients. The ears with OME that fails to resolve or recur should be managedwith myringotomy and VT insertion or adenoidectomy.Keywords: otitis media with effusion, myringotomy, adenoids; rhinosinusitis, tympanometryReferences
Paparella MM, Jung TT, Goycoolea MV. Otitis media with
effusion, Otolaryngology, Vol-II, 3rd edition, W.B. Saunders;
p. 1377–80.
Ullah Z, Ullah M, Ullah S. Surgical management of otitis media
with effusion; A prospective study of 120 patients. J Postgrad Med
Inst 2001;15(2):165–70.
Roberts JE, Rosenfeld RM, Zeisel SA. Otitis Media and Speech
and Language: A Meta-analysis of Prospective Studies. Pediatrics
;113(3):e238–48.
American Academy of Family Physicians, American Academy of
Otolaryngology-Head and Neck Surgery, and American Academy
of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis
Media with Effusion. Pediatrics 2004;113(5):1412–29.
Karlidag T, Kaygusuz I, Ozden M, Yalsin S, Ozturk L. Resistant
bacteria in the adenoid tissues of children with otitis media with
effusion. Int J Pediatr Otorhinolaryngol 2002;64(1):35–40.
Mills RP, Irani BS, Vaugahan-Jones RJ. Padgham NM. Maxillary
sinusitis in children with otitis media with effusion. J Laryngol
Otol 1994;108:842–4.
Hong CK, Park DC, Kim SW, Cha CI, Cha SH, Yeo SG. Effect of
paranasal sinusitis on the development of otitis media with
effusion: influence of eustachian tube function and adenoid
immunity. Int J Pediatr Otorhinolaryngol 2008;72:1609–18.
Yeo SG, Park DC, Eun YG, Cha CI. The role of allergic rhinitis in
the development of otitis media with effusion: effect on eustachian
tube function. Am J Otolaryngol 2007;28(3):148–52.
Donaldson JD. Acute otitis media. presentation. 2011. Available
at: http://emedicine.medscape.com/article/859316-overview
Butler CC, MacMillan H. Does early detection of otitis media with
effusion prevents delayed language development? Arc Dis Child
;85:96–103.
Rashid D, Ahmad B, Malik SM, Rahat ZM, Malik KZ. Otitis
media with effusion—cost effective options. J Coll Physicians
Surg Pak 2002;12(5):274–6.
Yousaf M, Ullah I, Ahmad N, Ali S. The presentation pattern of
otitis media with effusion. J Med Sci 2009;17(1):53–5.
Rovers MM, Black N, Browning GG, Maw R, Zielhuis GA,
Haggard MP. Grommets in otitis media with effusion: an
individual Meta analysis. Arch Dis Child 2005;90:480–5.
Butler CC, Van Der Voort JH. Oral or topical nasal steroids for
hearing loss associated with otitis media with effusion in children.
Cochrane Database Syst Rev 2002;(4):CD001935.
Ahmad SU, Choudhary M, Haque RM. Influence of adenoid
hypertrophy on otitis media with effusion: Bangl J
Otorhinolaryngol 1997;3(1):3–8.
Marcy SM, Shiffman RN. Otitis media with effusin. Clinical
practice guidelines. Pediatrics 2004;113:1412–29.
Hassmann E, Skotnicka B, Baczek M, Piszez M. Laser
myringotomy in otitis media with effusion: long term followup.
Eur Arch Otorhinolaryngol 2004;261:316–20.
Roland PS, Kreisler LS, Reese B, Anon JB, Lanier B, Conroy PJ,
et al. Topical ciprofloxacine/dexamethasone otic suspension is
superior to ofloxacine otic solution in the treatment of children
with acute otitis media with otorrhea through tympanostomy
tubes. Pediarics 2004;113(1 part 1):40–6.
Maw AR. Development of tympanoscerosis in children with otitis
media with effusion and ventilation tubes. J Laryngol Otol
;105:614–7.
Malik KI, Butta ZI, Mukhtar N, Pal MB. Role of grommets in
otitis media with effusion. Ann King Edward Med Coll
;9(3):211–3.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
