A clinical study to determine the e ects of adenoidectomy in cases of secretory otitis media in school going children

A clinical study to determine the e ects of adenoidectomy in cases of secretory otitis media in school going children Santosh D.1, Sumanth D.2*, Veeranjaneyulu P.3, Deepthi B.4, Mamatha K.5 DOI: https://doi.org/10.17511/jooo.2020.i08.01 1 B Krishna Santosh, Associate Professor, Department of ENT, GSL Medical College, Rajahmundry, Andhra Pradesh, India. 2* K Krishna Sumanth, Assistant Professor, Department of ENT, GSL Medical College, Rajahmundry, Andhra Pradesh, India. 3 Panda Veeranjaneyulu, Professor and Head, Department of ENT, GSL Medical College, Rajahmundry, Andhra Pradesh, India. 4 Deepthi B, Junior Resident, Department of ENT, GSL Medical College, Rajahmundry, Andhra Pradesh, India. 5 Mamatha K, Junior Resident, Department of ENT, GSL Medical College, Rajahmundry, Andhra Pradesh, India.


Introduction
Secretory otitis media (SOM) is one of the most common medical problems of childhood. It is the leading cause for office visits a common reason for prescribing antibiotics and the most frequent reason that children undergo surgery [1,2]. There are many challenges in the management of an otitisprone child. Increasing antibiotic consumption is related to the emerging phenomenon of antimicrobial resistance [3].
When the long-term impact of SOM is considered, surgical therapy is the most cost-effective than medical therapy for severe cases [4]. Historically, myringotomy, adenoidectomy, tympanostomy tubes, and even tonsillectomy have been advocated [4].
SOM is the leading cause of hearing loss in children.
Prolonged or fluctuating hearing impairment in early childhood may result in long-term consequences for speech and language development. With these, a study was conducted to find the effect of adenoidectomy in cases of SOM with hypertrophied adenoids and to determine the effect of adenoidectomy on hearing as assessed by the pure tone and impedance audiometry. decongestants, and antihistamines. They were discharged after 24 hours. All patients were followed up after one week and then at the 1st, 3rd, and 6th month of surgery, PTA was done to assess improvement in hearing. Impedance Audiometry was also done at the 6th month to see for the occurrence of the peak. Any respiratory infection during this period was promptly treated.

Results
In this report, a total of 50 SOM cases with adenoid hypertrophy was studied. The incidence of secretory OM was highest (60%) in the 5-7 years age group (   Otoscopic findings of the tympanic membrane (TM) showed the dull, lustreless, amber color was the most common (78%; 39) common finding followed by retraction (50%; 25) and air bubbles (10%; 5) ( Table 3).  Hearing improvement during the 1st month was 13dB, at the 3rd month was 13.2dB and at the 6th month was 12.7dB compared to preoperative findings ( Table 5). As the p-value is 0.0001, that is <5%, hearing improvement at 1st, 3rd, and 6th month was statistically significant (Table 5).

Discussion
The present study included children aged 5-12 years, the majority of study members were between 5 -7 years age group and the mean age was 7.5 years. Brooks et al [7] in their study showed 50% of the patients were in the age group of 5 -7 years. Maw et al. observed that adenoidectomy alone produced no peak/peak conversion in 29.8% of children [18]. In the present study, also 33% of children showed no peak/peak conversion at 6 months. However, in the rest of the patients, an Maw randomly assigned 103 children from 2-12 years of age with bilateral OME to one of 3 groups: adenotonsillectomy (n=34), adenoidectomy (n=36), or neither (n=33). At surgery, one ear was randomly assigned to receive a tympanostomy tube.
At 3, 6, 9, and 12 months, the clearance of effusion in the unoperated ear was recorded. A single shepherd tube alone gives a short-lived effect of 10 months whereas adenoidectomy produces a significantly longer-lasting effect for several years [27]. Myringotomy and aspiration of fluid in some studies showed a dry tap rate up to 34% [28]. Relationships between nasopharyngeal dimensions and the presence of OM with effusion have been shown [29].
Based on these observations, in the current study adenoidectomy was performed in all patients and tonsillectomy when the indication was present. All patients were regularly followed up postoperatively. What does the existing study add to the existing knowledge?
SOM is one of the common clinical findings among children, boys category is slightly more affected.