Prevalence of Asymptomatic Otitis Media with Effusion in Children with Adenoid Hypertrophy and its Relation to Adenoid Size: A Cross-sectional Study

Introduction: Otitis Media with Effusion (OME) occurs as a sequela of adenoid hypertrophy. But most often hearing loss due to OME goes unnoticed in children. This causes poor cognitive development, inattention and thus poor scholastic performance. Aim: To estimate the frequency of asymptomatic OME in children with adenoid hypertrophy and to find the association between adenoid size and occurrence of OME and hearing loss. Materials and Methods: The present study was a prospective cross-sectional study conducted in a tertiary care centre in South India from November 2019 to November 2021. Children of 5-12 years of age, with symptoms suggestive of adenoid hypertrophy and with no complaints of hearing loss, were selected. A detailed ear, nose, throat examination, Pure Tone Audiometry (PTA) and tympanometry were done in all patients. Adenoid size was graded by nasal endoscopy using Mc Murray and Clements scale and also based on radiographs (comparing the distance between maximum convexity of adenoid and line drawn along basiocciput (A) and posterior part of hard palate and sphenobasioccipital synchondrosis (N)) using A/N ratio. All patients subsequently underwent adenoidectomy. Myringotomy was done along with adenoidectomy in cases with bilateral OME. All OME patients were followed-up with tympanometry, one month and three months postoperatively. The frequency of OME was presented as percentage. The association between adenoid size and asymptomatic OME as well as hearing loss was done using Fisher's exact test. Results: A total of 150 children between 5-12 years with adenoid hypertrophy were analysed. The mean age was 9 years. On analysing the association between adenoid size (both radiographically and endoscopically) and OME, 30 (20%) had bilateral effusion and 18 (12%) had unilateral effusion and prevalence of asymptomatic OME was calculated as 32%. Most of the patients had Grade 2 adenoids radiographically, and Grade 3 adenoids as per nasal endoscopy. Majority of patients had Type B Tympanogram. There was significant association between OME and adenoid size. Association between adenoid size with hearing loss showed significant association between the two with p=0.001 on right ear and p<0.001 on left ear (radiographically), and p=0.0027 on right ear and p=0.043 on left ear (as per nasal endoscopy). About 93% of children with bilateral Type B tympanogram and all children with unilateral Type B and bilateral Type C returned to normal on three months follow-up. Conclusion: There was association between adenoid size, and occurrence of OME and hearing loss. About 32% of the study population were detected to have asymptomatic OME.