Influence of Adenoid Hypertrophy on Secretory Otitis Media

1981 ◽  
Vol 90 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Hans H. Elverland ◽  
Olav K. Haugeto ◽  
Iain W. S. Mair ◽  
Knut E. Schrøder
Keyword(s):  
Otitis Media ◽  
Nasal Obstruction ◽  
Clinical Course ◽  
Adenoid Hypertrophy ◽  
Secretory Otitis Media ◽  
Pathogenetic Mechanisms ◽  
Tympanostomy Tubes ◽  
First Recurrence ◽  
Observation Period

The prognostic influence of adenoidectomy on the clinical course of chronic secretory otitis media (SOM) is reported after an observation period of five years in 166 children. Adenoidectomy was performed in connection with the first tubulation on the basis of concurrent symptoms of nasal obstruction, and resulted in a significant reduction in the need for repeated insertion of tympanostomy tubes in patients younger than eight years of age. The tubulation rate was also significantly reduced when adenoidectomy was performed in association with the first recurrence of SOM. This effect was, however, absent when the operation was performed at later stages, and both the otoscopic and audiological findings after five years revealed no significant differences between the adenoidectomy and nonadenoidectomy groups. Possible pathogenetic mechanisms leading to the development of SOM in the presence of large adenoids are discussed.

Chronic Secretory Otitis Media: Effects of Surgical Management

1989 ◽  
Vol 98 (1_suppl2) ◽  
pp. 2-32 ◽  
Author(s):  
George A. Gates ◽  
J. C. Cooper ◽  
Christine A. Avery ◽  
Thomas J. Prihoda
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Surgical Management ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Secretory Otitis Media ◽  
Tympanostomy Tubes ◽  
The Mean ◽  
First Recurrence

To study the effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 4- to 8-year-old children to receive one of the following: Bilateral myringotomy and no additional treatment (group 1), tympanostomy tubes (group 2), adenoidectomy and myringotomy (group 3), or adenoidectomy and tympanostomy tubes (group 4). The 491 who accepted surgical treatment were evaluated at 6-week intervals for up to 2 years. Treatment effect was assessed by four main outcomes: Time with effusion, time with hearing loss, time to first recurrence of effusion, and number of surgical re-treatments. For the groups (in order), the mean percent of time with any effusion in either ear was 49, 35, 30, 26 (p < .0001); the mean percent of time with hearing thresholds 20 dB or greater was 19, 10, 8, and 7 (p < .0001) in the better ear; and 38, 30, 22 and 22 in the worse ear (p < .0001); the median number of days to first recurrence was 54, 222, 92, and 240 (p < .0001); and the number of surgical re-treatments was 66, 36, 17, and 17 (p < .0001). The most notable adverse sequela, purulent otorrhea, occurred in 22%, 29%, 11%, and 24% of the patients assigned to groups 1 through 4, respectively (p < .001). In severely affected children who have chronic otitis media with effusion resistant to medical therapy, adenoidectomy is an effective treatment. Adenoidectomy plus bilateral myringotomy lowered posttreatment morbidity more than tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. Adenoidectomy appears to modify the underlying pathophysiology of chronic otitis media with effusion. This effect is independent of the preoperative size of the adenoid. Tympanostomy tube drainage and ventilation of the middle ear provide adequate palliation so long as the tubes remain in place and functioning. We recommend that adenoidectomy be considered in the initial surgical management of 4- to 8-year-old children with hearing loss due to chronic secretory otitis media that is refractory to medical management and, further, that the size of the adenoid not be used as a criterion for adenoidectomy. Concomitant bilateral myringotomy with suction aspiration of the middle ear contents also should be done, with or without placement of tympanostomy tubes at the discretion of the surgeon.

Delayed Onset Post-Tympanotomy Otorrhea

1988 ◽  
Vol 98 (2) ◽  
pp. 111-115 ◽  
Author(s):  
George A. Gates ◽  
Christine Avery ◽  
Thomas J. Prihoda ◽  
G. Richard Holt
Keyword(s):  
Health Care ◽  
Surgical Treatment ◽  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Secretory Otitis Media ◽  
Delayed Onset ◽  
Tympanostomy Tubes ◽  
Care Costs

Otorrhea is the most frequent complication of the use of tympanostomy tubes. When it occurs after the immediate postoperative period, otorrhea is probably the result of external contamination of the middle ear or acute otitis media. We analyzed data from 627 operations upon 1248 ears of 491 children with chronic secretory otitis media and found that delayed onset (longer than 7 weeks) postoperative otorrhea occurred after 26.4 percent of the 382 operations in which tympanostomy tubes were used. The average number of episodes of otorrhea per case was 1.46 and ranged from 1 to 9. The rate of otorrhea occurrence in patients with tubes in place was significantly higher in the summer months. Otorrhea also occurred after 9.0 percent of 245 myringotomy procedures. The average number of episodes was 1.32 and ranged from 1 to 3. Treatment of postoperative otorrhea increases the health care costs of surgical treatment of chronic otitis media with effusion; this problem should be included in the calculation of cost-effectiveness.

scholarly journals Fiberscopic Imaging of the Pediatric Nasopharynx

1995 ◽  
Vol 1 (3) ◽  
pp. 153-157 ◽  
Author(s):  
Deyun Wang ◽  
Peter Clement
Keyword(s):  
Otitis Media ◽  
Nasal Obstruction ◽  
Eustachian Tube ◽  
Correct Diagnosis ◽  
Adenoid Hypertrophy ◽  
Endoscopic Findings ◽  
Adenoid Tissue

This study describes the endoscopic findings about the size of the adenoid tissue and the condition of the nasopharyngeal orifice of the eustachian tube. Results confirmed that only fiberscopic examination allows a thorough inspection of the nasopharyngeal anatomy to make a correct diagnosis and design therapeutic planning. When the presence of adenoid hypertrophy resulting in nasal obstruction, snoring, and/or otitis media was confirmed endoscopically, adenoidectomy proved to be highly efficacious in relieving these symptoms.

Preliminary Report on L-Forms: Possible Role in the Infectious Origin of Secretory Otitis Media

1994 ◽  
Vol 103 (6) ◽  
pp. 434-438 ◽  
Author(s):  
Nebil Goksu ◽  
Sedef Bengisun ◽  
Haluk Ataoglu ◽  
Yusuf K. Kemaloglu ◽  
Suat Ozbilen
Keyword(s):  
Otitis Media ◽  
Clinical Course ◽  
Brain Heart Infusion ◽  
Secretory Otitis Media ◽  
Culture Methods ◽  
Conventional Culture ◽  
Infectious Origin ◽  
Infection And Inflammation ◽  
Responsible Pathogen ◽  
Middle Ear Cleft

Infection and inflammation of the middle ear cleft are important factors in the pathogenesis of secretory otitis media. Although high percentages of negative cultures are confronted in many studies, strong evidence pointing to the infectious nature of this disease could not be overlooked. Many authors agree about the failure of conventional culture methods in identifying the responsible pathogen or pathogens. Besides, some agents, such as some kinds of antibiotics, lysozyme, and perhaps some undetected materials, are capable of changing bacterial behavior and consequently the clinical course. Effusions taken from 40 ears with secretory otitis media were cultured by means of conventional brain-heart infusion broth and special hypertonic thioglycollate broth. Strikingly, bacterial L-forms were detected in 6 specimens in thioglycollate broth, with no growth in the conventional broth. We concluded that these atypical forms of bacteria, the L-forms, may play an important role in the bacteriologic aspect of secretory otitis media.

Adenoidectomy and Otitis Media

1992 ◽  
Vol 101 (1_suppl) ◽  
pp. 24-32 ◽  
Author(s):  
George A. Gates ◽  
Harlan R. Muntz ◽  
Brendan Gaylis
Keyword(s):  
Otitis Media ◽  
Pathogenic Bacteria ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Tube Insertion ◽  
Secretory Otitis Media ◽  
Randomized Controlled ◽  
Source Of Infection ◽  
Randomized Controlled Studies ◽  
Tympanostomy Tubes

Adenoid enlargement has traditionally been considered a factor in otitis media; adenoid size, however, does not appear to be correlated with otitis media occurrence. Presence of pathogenic bacteria in the adenoids of children with otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx. Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media. In one study comparing no treatment, adenoidectomy, and adenotonsillectomy, a significant benefit was seen with adenoidectomy that was not enhanced by tonsillectomy. Another study that compared adenoidectomy, tympanostomy tubes, and a combination of the two showed a significant reduction in effusion time and less surgical retreatment over 2 years in the two adenoidectomy groups. The third study demonstrated the effect of adenoidectomy in children with recurrent chronic otitis media with effusion after failure of tympanostomy tube insertion. All three studies showed that the effect of adenoidectomy was independent of adenoid size. This review discusses current concepts of adenoid physiology and pathology, the major adenoidectomy studies, and indications for the procedure.

Seropositive, adenoid hypertrophy, and secretory otitis media in adults—A recognized clinical entity

1992 ◽  
Vol 107 (6_part_1) ◽  
pp. 755-757 ◽  
Author(s):  
Shailesh Dhirubhai Desai
Keyword(s):  
Otitis Media ◽  
Strong Association ◽  
Antibody Test ◽  
Hiv Infections ◽  
Lymphoid Hyperplasia ◽  
Lateral View ◽  
Reactive Lymphoid Hyperplasia ◽  
Adenoid Hypertrophy ◽  
Secretory Otitis Media ◽  
Histopathologic Diagnosis

Otolaryngologic manifestations of AIDS have been described in the past. In this study, I had examined 14 adults with nasal obstruction and mouth breathing. Nine patients also reported deafness-unilateral in three of them and bilateral in six. All of them revealed a mass in the nasopharynx, either on the posterior rhinoscopy or the x-ray neck-lateral view. To exclude nasopharyngeal malignancy, all of the patients underwent examination of the nasopharynx while under general anaesthesia and biopsy. The histopathologic diagnosis in every patient was nonspecific, reactive lymphoid hyperplasia, which has been described in the background of HIV Infections. Four were already confirmed HIV-positive and 10 were found positive on the HIV antibody test. A strong association was established between seropositivlty, adenoid hypertrophy, and secretory otitis media in adults.

Tympanostomy Tubes: The Conservative Approach

1981 ◽  
Vol 90 (6) ◽  
pp. 529-532 ◽  
Author(s):  
R. F. Naunton
Keyword(s):  
Medical Treatment ◽  
Small Group ◽  
Otitis Media ◽  
Nasal Obstruction ◽  
Otitis Media With Effusion ◽  
Physical Activities ◽  
Conservative Approach ◽  
Clear Advantage ◽  
Tympanostomy Tubes

The clear advantage accruing from the use of tympanostomy tubes in the treatment of otitis media with effusion is immediate improvement in hearing; there are also disadvantages entailed, such as scarring of the drum, risk of continuing otorrhea and interference with the patient's normal physical activities. All possible forms of medical treatment should be exhausted (antihistamine decongestants, politzerization) before resorting to tympanostomy tubes. There is a small group of children with severe chronic nasal obstruction and otitis media with effusion for whom adenoidectomy is likely to be required.

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