Lechosław P. Chmielik, *Monika Jabłońska-Jesionowska
TREATMENT OF CHILDREN WITH HEARING DISORDERS AND ADENOIDS IN THE ENT PAEDIATRIC DEPARTMENT IN WARSAW DURING 2007-2008
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Enlargement of adenoids may lead to various pathological changes.
Otitis media with effusion (OMS) may be one of the consequences of enlarged adenoids, resulting from impaired patency of the Eustachian tube. Transitory hearing loss may be a consequence of OMS, but otitis media with cholesteatoma may also occur (1). Aim.
The authors analyzed cases of otitis media with effusion in children treated in the Department of Paediatric Otolaryngology to establish causes of hearing loss and effects of administered treatment. Material and methods.
Cases of 100 children with otitis media with effusion treated in the Department of Paediatric Otolaryngology, Medical University in Warsaw during 2007-2008 were analyzed. All children had adenoidectomy performed. Tympanotomy or drainage of the tympanic cavity with a ventilation tube was performed (1). Treatment results were analyzed on the basis of ambulatory documentation. Results.
Better results of the treatment of conductive hearing loss were achieved in the preschool-age group than in the school-age group of our patients. Conclusions.
The primary method of the treatment of otitis media with effusion is to restore patency of the Eustachian tube. In case of enlargement of the adenoids, adenoidectomy should be carried out as soon as possible to prevent chronic otitis media. The decision to carry out tympanotomy or use a ventilation tube should be made individually, on the basis of audiometry and on the intraoperative picture.
otitis media with effusion, conductive hearing loss, adenoidectomy, tympanostomy
Otitis media with effusion in children and its treatment is a very common problem. The effect of OMS is associated with fluid in the middle ear. Management of OMS can be conservative or surgical, and still remains controversial.
Children with conductive hearing loss were treated in the Department of Paediatric Otorhinolaryngology of the Medical University of Warsaw during 2007-2008. The causes of hearing loss and effects of treatment have been analyzed.
One hundred cases were analyzed. These were children aged from 3 to 12. 54 children were aged from 3 to 6 (preschool-age group), while 46 children were aged from 7 to 12 (school-age group). During physical examination we asked parents about: recurring infections of the upper respiratory tract, past ear infections and combined diseases, taking allergies into particular consideration. We paid attention to congenital malformations that could impair patency of the Eustachian tube, such as: Down´s syndrome, cleft palate and mucoviscidosis. We found recurring ear infections in 45% of examined children, past ear infections in 25% of children and allergy in 26% of children. We treated 4 children with Down´s syndrome and 2 children with cleft palate after plastic surgery of the palate. Before starting the treatment each child had audiometry performed using pure tone audiometry and acoustic impedance audiometry, as well as x-ray examination of the nasopharynx. In pure tone audiometry of 100 analyzed cases we found 17 cases of conductive hearing loss with cochlear reserve above 25 dB in one or both ears. The results of acoustic impedance audiometry were analyzed separately in preschool- and school-age groups. In the former group per 54 children, that is 108 ears, type A tympanogram was found in 67 ears, which constitutes 23%, type B tympanogram was found in 67 ears (62%) and type C tympanogram was found in 27 ears (25%). In the school-age group (7-12 years of age) type A tympanogram was found in 12 ears (23%), type B tympanogram was found in 58 ears (63%) and type C tympanogram was found in 22 ears (24%). X-ray examination revealed enlargement of adenoids reducing the lumen of the nasopharynx in 70 children.
All children were qualified for adenoidectomy or adenotonsillectomy in case of enlargement of the palate tonsils as well and for tympanotomy, that is only incision of the tympanic membrane (5). The decision to use a ventilation tube was made individually after tympanotomy. If there was no fluid in the middle ear, the tympanic cavity was irrigated with 0.9% NaCl and Solu-Medrol, while if fluid was present a ventilation tube was inserted after irrigating the tympanic cavity (2). In the preschool-age group a ventilation tube was inserted in 17 children (31%); in 11 children the drainage was bilateral. In half of cases adenoidectomy was performed and adenotonsillectomy in another half. In the school-age group ventilating drainage was performed in 16 children (36%); in 10 children the drainage was bilateral. Adenoidectomy was performed in 65% of children and adenotonsillectomy in 35%. In the remaining 67 children from both groups after performing tympanotomy no fluid was found in the tympanic cavity and a tube was not inserted (2).
In the preschool-age group (n = 54) in 48 (88%) children 3 months after the treatment we found type A tympanogram in impedance audiometry examination. 7 other children did not achieve hearing improvement and after 6-8 months a ventilation tube was inserted. In all these children allergy was found and treated. Two children had plastic surgery performed because of cleft palate. After additional administration of Otovent in 4 of them type A tympanogram was finally achieved and in 3 it was seen only periodically (4, 7). In the school-age group (n = 46) 3 months after the treatment hearing improvement was observed in 36 (78%) children with type A tympanogram in impedance audiometry examination. Another 8 children, after administration of Otovent (7) and conservative allergy therapy, achieved type A tympanogram after 6 months. In 4 children (9%) conductive hearing loss remains despite the treatment, with cochlea reserve in pure tone audiometry above 25 dB and type A or C tympanogram. In these cases CT scan of the temporal bone was performed and the children were referred for further surgical treatment.
Better results of the treatment of conductive hearing loss were achieved in the preschool-age group. Changes in the middle ear in younger children are caused by transitory dysfunction of the Eustachian tube resulting from recurring infections (6). In the school-age group worse outcomes result from established changes in the middle ear. In children with Down´s syndrome or hypothyroidism cochlear reserve in pure tone audiometry and type B tympanogram in impedance audiometry remain despite treatment.
1. The primary method of the treatment of otitis media with effusion is to restore patency of the Eustachian tube.
2. In case of the occurrence of otitis media with effusion in the course of enlargement of adenoids adenoidectomy should be carried out as soon as possible to prevent chronic otitis media.
3. The decision to perform tympanostomy or ventilation tube insertion should be made individually on the basis of the middle ear condition – presence or lack of fluid in the tympanic cavity (5).
4. Correct treatment, of appropriate duration, of recurring infections of the upper respiratory tract and allergies influences long-term hearing quality in children (6).