ISSN 1612-3352

Editors in Chief

Prof. Dr. Claus F. Claussen, Neurootological Research Institute of the Research Society for Smell, Taste, Hearing and Equilibrium Disorders at Bad Kissingen (4-G-F). Bad Kissingen, Germany.
Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

Production Managers

Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.


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Surgical therapy of secretory otitis media

Abstract

SOM, glue ear or chronic otitis media with effusion, is the commonest cause of deafness in children and the commonest reason that the children have surgery.
It is characterized by the presence of fluid in the middle ear cavity for 3 months or longer with minimal constitutional symtoms.
Pathogenesis appears to be multifactorial and risk factors associated persistence include obstructive processes in nasopharynx-adenoids, tumours, previous history of reccurent otitis or other infections of the upper respiratory tract, tubal incompetence, atopic history, passive smoke exposure, young age, infant feeding practices. Genetic components are discussed nowadays.
Effusions may cause pain, feelling of pressure or fullness in ear, conductive deafness (entire frequency range of 40 to 50 dB). Very often is SOM symtomless, the impetus for early detection and treatment of glue ear is concern that impaired hearing in early childhood affects language and speech development, learning and will lead to school and behavioural problems.
Otoscopy shows a markedly retracted tympanic membrane with localized protrussion, with a yellowish fluid level or air bubbles. Atypical impedance curve B is found.
Over 50 % of effusions resolve spontaneously within 8 weeks. Many drugs have been used to treat glue ear, but none improves long-term outcome – for example decongestants, antihistamines, mucolytics, antibiotics or oral steroids. From surgical operations we can call myringotomy – but it has often only temporary effect, adenoidectomy would be the first step in the therapy of child with glue ear and enlarged adenoids. Next surgical type of treatment is placement of ventilating tubes as a single procedure or combination of grommets and adenoidectomy in one time
The aim of our study was to evaluate benefit of adenotomy in inhalational or endotracheal anesthesia without endoscopic control compared to benefit of endoscopic adenotomy. We evaluated the presence of SOM in children operated for adenotomy, before and 6 weeks after operation, tympanometry and otomicroscopy investigation were performed to confirm suspected glue ear.
We did retrospective study of surgical treatment of secretory otitis. We compared three cohorts of patients in dependence on technique of adenotomy. The first one was group of 64 children, in which adenoidectomy was performed under the general anesthesia without endoscopic control. The second was group of 467 children operated without endoscopy but partly in endotracheal anesthesia. In the last one was adenotomy performed with endoscopic control, in years from l997 to 2000. In this group were 323 children included.
The age of the children was from 2 to l5 years, average age were in our groups from 5, 1 years to 5,5 years. Age and sex of the children were comparable.In first group were operated under the general inhalational anesthesia 64 children in period from September to November l986. Impedance curves were: before adenotomy 20 % of type A ,53 % of type B and 36 % of type C. After our surgical treatment it were 42 % of type A, 22 % of type B and 36 % of type C.

In the second period in the years l992-93 were 467 children operated. From this total number were 376 adenotomies and 91 readenotomies. SOM was present in 38 % in cases of simple adenoidectomy, in readenotomies it was in 64%. Type of anesthesia was inhalational, in readenotomies we used intubation with endoscopic control.
In the last group of 323 children we used during the operation endoscopic control. Before output were 42 % of impedance curves type A, 35 % of type B and 23 of type C. In postoperative follow – up were in 80% type A, in 9 % type B and in l1% type C.

The higher incidence of postoperative normalisation in group with endoscopic control of the impedance curves is clear from this graph. In the operations without endoscopy were 42% of type A, with endoscopy –80 %.
Persistent SOM ( it means type B of tympanogram) –is in the first group 22% in the third only 9%.

In cases of persistent B type of tympanogram we controled children 3 months later. If SOM was still present, the placement of grommets was indicated. In l986 it was 22% of the cases, in l992-93 it was 18 % and the lowest number was in the third group-9%.
The advantage of adenoidectomy under the general endotracheal anesthesia by endoscopic approach is-better view in the operative field, with lower risk of postoperative complications, better manipulation with curret and in our opinion lower frequency of readenotomies and of course –more cured patients with secretory otitis media.

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