The ear-adenoid nexus: Unraveling the impact of adenoid hypertrophy size on asymptomatic otitis media effusion

Introduction: Adenoid hypertrophy may lead to a condition called Otitis Media with Effusion (OME). However, hearing loss caused by OME is frequently overlooked and remains asymptomatic in children. This oversight can have adverse effects on cognitive development and academic 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. Materials and Methods: This cross-sectional observational study was conducted at a tertiary care center in Mirzapur, Tangail, Bangladesh, with 124 patients spanning from April 2023 to September 2023. The study focused on children aged 5 to 12 who displayed adenoid hypertrophy symptoms but had not reported any hearing issues. It involved a thorough clinical examination of the ear, nose, and throat. Additionally, all patients underwent tympanometry. Adenoid size was assessed by using nasal endoscopy and radiographs using Mc Murray and Clements scale. The prevalence of OME was expressed as a percentage, and Fisher's exact test was utilized to analyze the relationship between adenoid size and the presence of asymptomatic OME. Results: Data from 154 cases of adenoid hypertrophy were analyzed. The commonest age of presentation was 5-8 years (66.9%). Otoscopy found that 71 individuals (equivalent to 56.26%) had a normal tympanic membrane on both sides. And the majority (13.7%) had bilateral air-fluid levels. 67.7% of participants with adenoid hypertrophy had no effusion, and 32.3% had otitis media with effusion. This connection between endoscopic and radiological adenoid size and OME was statistically significant, with a p-value of less than 0.05. Impedance audiometry showed that most candidates (52.8%) presented with a 'B' type tympanogram. That indicates many participants with OME were not identified clinically but diagnosed by impedance audiometry. Conclusion: There was an association between adenoid size and the occurrence of OME. Among the study participants, approximately 32.3% were clinically identified as having asymptomatic OME.