MANAGEMENT OUTCOME OF SECRETORY OTITIS MEDIA

Authors

  • Farida Khan
  • Muhammad Asif
  • Gulshan Hussain Farooqi
  • Shahid Ali Shah
  • Tahira Sajid
  • Rehman Ghani

Abstract

Background: Secretory otitis media is a common otological manifestation, that most of the timeis left undiagnosed on account of unawareness and negligence in seeking early medical attentionfor trivial ailments. Untreated, it might end up in serious consequences in the form of poor speechand intellectual development and permanent anatomical disabilities within middle ear cleft. Theobjectives of the study were to determine most affected age group, the common etiological factors,to access the efficacy of medical and surgical treatment and finally to find out the complicationassociated with the surgical procedures. Methods: This study was conducted in the ENT, Headand Neck Surgery department of the Ayub Teaching Hospital, Abbottabad from January 2001 toDecember 2003.Only the diagnosed cases of SOM were included in the study. After detailedhistory, clinical examination, routine investigations and special investigations such as pure toneaudiogram and tympanometry were carried out to confirm the diagnosis of SOM . All patientswere initially treated by medical therapy. In cases of failure, underwent myringotomy with orwithout ventilation tube insertion and where indication present adenotonsillectomy and antrallavage was done. Follow up of cases was carried out from 18-24 months. Results: It included 87patients, 58 were males (66.6%) and 29 females (33.3%). Majority of the patients were between5-8 years (62%). The most common aetiological factor was rhinosinusitis (36.7%) followed byhypertrophic adenoids (34.5%). All patients were initially given medical treatment. Out of 87patients,30 patients (34.4%) improved and 57 patients (65.5%) had no response and underwentsurgery. Surgical procedures included myringotomy with and without ventilation tube insertion,adenotonsillectomy and antral lavage. Conclusion:It is concluded from this study thatconservative treatment has a definite role and should be tried before any surgical step is takenhowever surgery is the treatment of choice in more resistant cases.Key Words: Secretory otitis media, otitis media with effusion, myringotomy

References

Goycoolea MV, Hueb MM, Ruach C. Definations and

terminology of otitis media. Otolaryngologic clinics of North

America 1991; 24:757– 61.

Jalisi M, Jazbi B. Chronic middle ear effusion. Current

problems in otorhinolaryngology. Pakistan Doctors

Publication 1991; 85-97.

Abdou M, Adenoids and chronic secretory otitis media.

Pakistan J Otolaryngol 1991;7:134 – 37.

Talat AM, Gomma k, Baghat Y, Elwany S, Abdou M.

Adenoids and chronic secretory otitis media. Pakistan J

Otolaryngol 1991;7:194-7

Finkelstein Y, Talmi YP, Rubel Y, Bar Ziv J. Otitis media

with effusion as a presenting symptom of chronic sinusitis.

J.laryngol otol 1989;103: 827-832.

Yaginuma Y, Kobayashi J, Takasaka T. The habit of sniffing

in nasal Diseases as causes of secretory otitis media. Ann J

Otol 1996; 17 (1): 108 -10.

Sriwardhana KB, Howard AJ, Dunkim KT. Bacteriology of

otitis Media with effusion. J laryngol otol 1989;103:253-6.

TOS.M Etiology and prevalence of secretory otitis media.

Ann of otol Rhinol – laryngol 1990;146 (99) 5-27.

Paradise JL, Rockette HE, Colborn DK, Bernard BS, Smith

CG, Kurs-Laskym M, et al. Otitis media in 2253 Pittsburgharea infants;prevalence and risk factors during the first two

years of life. Pediatrics 1997; 99:318-33

Chan KH, Swarts JD, Rudoy R, Dever GJ, Yuji M. Otitis

media in the republic of palau. Arch otolaryngol. Head Neck

Surg 1993; 119:425-28

Daly KA. Epidemiology of otitis media. Otolaryngologic

clinics of North America 1991; 24: 775– 82.

Ahlo OP, Oja H, Koivu M, Sorri M. Risk factors for chronic

otitis media with effusion in infancy, each acute Otitis media

episode induces a high but transient risk.Arch Otolaryngol

Head Neck Surg 1995; 121:839-43.

Bennet KE, Hoggard MP, Silva PA, Steward IA. Behaviour

and developmental effects of otitis media with effusion into

the teens. Arch Dis Child 2001; 85: 91-5

Augustsson I, Engstrand I. Otitis media academic

achievement int.J. Paediatric Otorhinolaryngol 2001;57:31-

Padgham N, Mills R, Chistmas H. Has the increasing use of

grommets Influenced the frequency of surgery for

cholesteasftoma J. of laryngol and otol 1989;103:1034-5.

Williamson JG, Dunleavey J, Robinson BA. A natural

history of otitis Media with effusion. J Laryngol & otol 1994;

: 930 -34.

Hogon SC, Stratford KJ, Moore DR. Duration and recurrence

of oitis media With effusion in children from birth to 3 year,

prospective study using Monthly otoscopy and

tympanometry. B M J 1997; 314-350.

Midgley EJ, Dewey C, Pryeek, Maw AR, ALSPAC study

team. The Frequency of otitis media with effusion in British

pre School children a guid for treatment. Clinical

otolaryngol 2000;25:485-91.

Gates GA. Adenoidectomy for secretory otitis media with

effusion Ann otol – rhinolaryngol 1994; 103: 54 – 57.

Saeed M, Ajmal M, Secretory otitis media in adults. Pakistan.

J otolaryngology 2003; 19:38-40

Bernstein JM. Role of allergy in Eustachian tube blockage

and otitis media with effusion: A review Otolaryngol-HeadNeck-Surg 1996;114(4):562-68.

Shahedin , Raza A , Khan N S, Sattar F, Jan A. Management

of secretory otitis media in children JPMI 2005:19 ((01):

-110.

Rosenfeld RM. Post JC. Meta analysis of antibiotics for the

treatment of otitis media with effusion 1992; 106: 378-386.

Williams RL, Chalmers, TC, Stange, RC, Chalmer T,

Browlins SJ. Use of Antibiotics in preventing recurrent acute

otitis media & in treating otitis media with effusion a Meta

analytic attempt to resolve the brouhaha. J of American

medical association 1993; 270 (11) 1344 – 51.

Coyle PC. Croxford R, MC Isaac W, Feldman W, Friedberg

J. The role of Adjuvant Adenoidectomy & tonsillectomy in

the out of the insertion of tympanostomy tube N Engl J. Med

; 344: 1188 – 95.

Ryding M, White P, Kalm O, Course & longterm outcome of

Refractory Secretory Otitis Media J Laryngol otol 2005;119:

– 118.

Isaacs D. The management of otitis media with effusion.

Current options in paediatrics 1994; 6: 3-6.

Talmon Y, Gadman H , Samet A, Gilbey P, Letichevsky V.

Ventilation with self manufactured polyethylene T tubes for

the treatment of children with middle ear effusion. J Laryngol

otol 2001; 115 :699 – 703.

Hern JD, Hasnie A, Shah NS, A long term review of the shah

pavmavent tube. J laryngol otol. 1995; 109: 277 – 80.

Riley DN, Herberger S, Mc Bride G, Law K. Myringotomy

& ventilation tube Insertion. J of laryngol otol 1997; 111:

-61.

Le CT, Freeman DW, Fireman B1, Evaluation of ventilating

tubes and Myringotomy in the treatment of recurrent or

persistent otitis media . J.Paediatric infections diseases 1991;

: 2-1.

Levine S, Daly K, Giebink GS. Tympanic membrane

perforation and tympanostomy tubes. Ann otol Rhinol

laryngol 1994; 103: 27 – 30.

Kumar M, Khan MA, Davis S. Medial displacement of

grommets an unusual sequel of grommet insertion. J laryngol

& otol. 2000;114: 448 – 449.