Comparison of Adenoidectomy With and Without Grommet Insertion in Cases of Adenoid Hypertrophy with Otitis Media with Effusion

INTRODUCTION: Secretory otitis media with effusion (OME) is the accumulation of mucus within the middle ear and sometimes in mastoid air cell system. Most of the time it is bilateral. Hearing impairment being the most common presentation leading to delayed speech and language development, poor academic performance and behavioural problems. This study is the comparison of adenoidectomy with and without grommet insertion in patients with adenoid hypertrophy with OME. REVIEW OF LITERATURE: In the article by Ilaupadhya and J. Datar , it is given that patients with adenoids in OME gave 100% result after surgical removal of the same. But a meta analysis on patients with OME by M MRovers, NBlack, G G Browning, R Maw says ventilation tubes might be used in young children that grow in an environment with high infection load. Many other articles says that adenoidectomy combined with grommet insertion is always superior to adenoidectomy alone in cases with adenoid hypertrophy with OME. AIMS AND OBJECTIVES: To compare the effectiveness of adenoidectomy with and without grommet insertion in treating patients with grade 3 or grade 4 adenoid hypertrophy with OME ,in 2-12 yrs of age. 1. To compare its long term effects. 2. To identify the post operative hearing improvement. 3. To identify the distribution of age and sex in cases with adenoid hypertrophy with OME. 4. To arrive at the best treatment modality of Adenoid Hypertrophy with OME and to compare the published literature. METHODOLOGY: This study will be conducted in the Department of ENT, Coimbatore Medical College Hospital, Coimbatore during the study period (January 2018 - January 2019). Children 2-12yrs with adenoid hypertrophy (Grade 3 & 4) with OME who gives consent are selected .They are randomly divided into two groups A and B. For group A, only adenoidectomy is done and for group B, adenoidectomy with grommet insertion is done. Each group is followed up every 2 weeks for 3 months and their improvement, recurrence and hearing level is studied using otoendoscopy findings, tympanogram and pure tone audiometry RESULTS In our study, the predominant age group was between 2-5 years (34%) and 8-11 years (34%). Mean age was 6.96. Higher incidence in male (62%) than female (38%) children. Pre operatively, 63% ears had dull tympanic membrane and 37% ears had amber coloured tympanic membrane. All the patients had B type tympanogram curve. Post-operatively, at the end 6 months of follow up, patients who underwent Adenoidectomy with grommet insertion had 94% normal tympanic membrane , 92% had type A tymanogram curve, mean PTA of 8.47 with P value of < 0.001 and 84% patients had AB Gap < 10dB. While, patients who underwent Adenoidectomy alone had 72% normal tympanic membrane, 64% had type A tympanogram curve, mean PTA of 15.40 dB with P value of < 0.001 and AB Gap of < 10dB in 64% of children. CONCLUSION: Though there are many treatment options available, surgical management in the form of adenoidectomy/myringotomy with grommet insertion has better outcome in terms of hearing improvement and disease relapse and recurrence. Combined treatment options have even more better outcomes. If the principle objective of the surgery for glue ear is to restore hearing then our study shows insertion of grommet is the treatment of choice. The addition of adenoidectomy will increase the likelihood of restoration of normal function of the middle ear and prevents recurrent episodes. Hence, I would like to conclude my study stating that, in children with adenoid hypertrophy with otitis media with effusion, Adenoidectomy combined with grommet insertion has better long term hearing improvement and least rate of recurrence of the disease.