The frequency of otitis media with effusion in patients undergoing adenotonsillectomy

Background: Otitis media with effusion (OME) is one of the most common pediatric health problems especially among young children. It is a condition characterized by accumulation of non-purulent fluid in the middle ear cleft. It may cause serious morbidity to the patient as hearing loss and delayed speech and language development. Objectives: To study the frequency of OME in patients undergoing adenotonsillectomy and to assess the effect of adenotonsillar hypertrophy as an etiological factor. Patients and Methods: This is a clinical observational case-based study was done during the period from June 2012 to January 2013 in the Department of Otolaryngology of Al-Yarmouk Teaching Hospital including 150 patients (aged 4 to 15 years) who visit the outpatient department for various indications for tonsillectomy with or without adenoidectomy). Ear examination was done to all patients and tympanic membrance (TM) features (color, position, air-fluid level, air bubbles and mobility) were recorded. The size of palatine tonsils was evaluated by clinical examination and classified into five grades (0, +1, +2, +3, +4) while adenoid was assessed by flexible nasendoscope and classified into 4 grades (grade 1, 2, 3, 4). Hearing assessment was done using either pure tone audiometry (P.T.A) or free field test in the uncooperative patients. Impedance audiometry was done to assess middle ear pressure. Results: A total of 27 of 150 patients (18 %) were diagnosed to have OME and the majority aged 6-7 years old (12 patients, 44.5%). Seventeen patients (62.9%) were males and 10 patients (37.1%) were females. Nineteen patients (70.4%) had bilateral involvement and 8 patients (29.6%) were unilaterally involved. The TM features were dull color in 28 ears (60.8%), retracted TM in 35 ears (76.1%), impaired mobility in 24 ears (66.7%), air-fluid level in 5 ears (10.9%) and air bubbles in 4 ears (8.7%). Regarding adenotonsillar grading, the common tonsillar grade was +2 (16 patients, 33.3%) while the common adenoid grading was grade 4 (11 patients, 40.8%). Hearing loss was identified in the majority of cases (23 patients, 85.2%) to be in the range of 20-40 dB HL. Impedance audiometry showed that 41 ears (89.1%) had type B tympanogram and 40 ears (86.9%) had negative stapedial reflex. Myringotomy was done in 46 ears. Positive tap was obtained in 43 ears (93.5%). Serous fluid discovered in 26 ears (56.6%) while glue was discovered in 17 ears (36.9%). Conclusion: The frequency of OME is directly related to adenoid hypertrophy regardless the degree of palatine tonsils grading.