Discussion
deafness, bleeding, Adenoid enlargement, hearing loss, adenotonsillar hypertrophy, edema, Eustachian tube dysfunction, adenoid hyperplasia, OME, temporary dysfunction of Eustachian tube, pain, infection, fullness, hypoacusis, adenoid hypertrophy, adenoid tissue hypertrophy, Eustachian dysfunction
MIDDLE EAR EFFUSION, BLEEDING, HEARING LOSS, ADENOTONSILLAR HYPERTROPHY, BLOOD CLOTS, EDEMA, ADENOID HYPERPLASIA, EUSTACHIAN TUBE DYSFUNCTION, RECURRENT OTITIS MEDIA, HEARING IMPAIRMENT, INFECTION, ADENOID HYPERTROPHY, MIDDLE EAR
Adenoid enlargement is an important cause for Eustachian tube dysfunction and recurrent otitis media in pediatric population. In recent study by Somayaji et al., incidence of adenoid hypertrophy was more in 4–6-year age group, followed by 7–9-year age group. This observation was similar to the study by Fujioka et al., which showed that the size of adenoid varies among children, but the maximum size was between 4 and 8 years age, which then regress gradually by 15 years of age. There was no significant difference in the gender distribution of incidence of adenoid hypertrophy [Children with OME may remain asymptomatic. Some present with deafness or ear fullness. In the present study, 12 children (22.2%) had hearing impairment. This incidence varies depending on the study. In a similar study by Kindermann et al. to investigate whether the obstruction of the Eustachian tube orifice due to adenoid hyperplasia causes a change in the MEP showed that the incidence of hearing loss to be 16% (8 out of 50 children). Sarafoleanu et al., in their study, showed the implications of adenoid tissue hypertrophy in the genesis of Eustachian tube dysfunction observed the incidence of hypoacusis to be 77.8%. In another study by Khayat and Dabbagh to identify the incidence of OME in children with adenoid hypertrophy, 22 (50%) out of 44 children with OME had deafness which was detected by statements of parents and teachers. Enache et al. in his study on 119 children with OME observed that all children presented with a history of deafness [In a study by Somayaji et al., otoscopy findings showed varied appearance of TM. 24% (26 ears) showed air–fluid level and 17.6% (19 ears) had dull and retracted TM. Tympanogram results revealed pathological curves in 45 ears (25% Type B curve and 16.7% Type C curve). Sarafoleanu et al. in his study observed that 28.57% had retracted TM and 49.2% had middle ear effusion. Furthermore, tympanogram results showed pathologic curves in 98 cases (40.47% Type B curve and 37.30% Type C curve). In a similar study by Khayat and Dabbagh also, the otoscopic findings were varied with distorted cone of light, retraction of TM, and air bubbles. A study by Ajayan et al. conducted to study the effect of adenoidectomy with tonsillectomy in pediatric patients with OME, showed dull and retracted TM in 78.5% cases and air–fluid was seen only in 11.42% [In a study by Somayaji et al., the difference between the two techniques (one group for conventional adenoidectomy and another for microdebrider adenoidectomy) was statistically significant (These observations were similar to the study by Choi et al. to evaluate the effect of adenotonsillectomy on immediate Eustachian tube function in children with adenotonsillar hypertrophy. He observed that majority had C Type of curve. On postoperative day 2, 76% (38/50) of cases were unresolved (CC and BB types), while 24% (12/50) were normal (AA type) or resolved (CA type). There was a statistically significant difference (Similar results were observed in a study by Unlu et al. to analyze the changes in the MEP in the early period after adenoidectomy in children with adenoid hypertrophy without OME. He observed that there was a pathological decrease in the MEP 24 h after the procedure in one ear in 48 patients (75%) and bilateral Eustachian dysfunction in 38 patients (59.3%). Furthermore, Type B tympanogram was not seen in any patients, postoperatively. These changes in MEP returned to preoperative value by 7th postoperative day [The increase in hearing threshold and reduction in MEP in the immediate period could be due to temporary dysfunction of Eustachian tube due to edema or blood clots at the surgical site, especially around Eustachian tube orifice. Moreover, due to pain in the postoperative period, swallowing is reduced, and this also adds on to the cause for Eustachian tube dysfunction [In a study by Somayaji et al., there was a significant improvement in the MEP and hearing threshold at 6 weeks following surgery as seen with PTA and tympanometry. There was a complete resolution of OME in 15 out of 16 children as suggested by postoperative Type A tympanogram. Similar results were observed in a study by Tuohimaa and Palva. A similar study by Zaman and Borah also showed that there was a significant improvement in the MEP following adenoidectomy [Sandooja et al. in his study on effect of adenotonsillectomy on hearing threshold and MEP also has shown improvement in MEP and hearing threshold following surgery and hence concluded that adenoidectomy improves the Eustachian tube function and MEP by eliminating the mechanical obstruction, edema of Eustachian tube orifice due to repeated infection [Similar results were observed in a retrospective study by Enache et al. At 1 month after surgery, a normal Eustachian tube function was seen in 43.70% of the children and at 3 months after surgery, when the second reassessment was made, 109 children (91.60%) presented a total recovery of the middle ear function with a normal Eustachian tube activity [Ajayan et al., in his study, observed that 6 weeks following surgery, 55.71% of Type B tympanogram changed to Type A and 15.7% to Type C, while in 28.57%, Type B persisted. After 3 months, 65.71% of tympanogram were Type A and 8.57% were Type C. In 25.71% of subjects, Type B tympanogram persisted. It was also observed that, in all those subjects with persistent Type B tympanogram, preoperative hearing loss was higher, that is, between 40 and 50 dB [In the present study, one case (2%) had persistent OME bilaterally as suggested by persistence of Type B tympanogram and reduced MEP. This could be due to persistence of Eustachian tube dysfunction [In another study, comparing effect of tonsillectomy and adenotonsillectomy over the tubal function, they discussed that there is a transient negative middle ear pressure in the early postoperative period more after adenotonsillectomy, then adenoidectomy and least after tonsillectomy with complete resolution one month postoperatively [Cost difference between the coblation and microdebrider blade versus conventional technique is always matter of discussion in different techniques of adenoidectomy. Though cost assessment was not studied as primary outcome of the present study, coblation technique had cost more than for microdebrider or conventional techniques. Although, coblation had better results on postoperative tympanographic findings but it had more cost with less bleeding rather than conventional technique. Microdebrider technique had less cost with mostly similar results in tympanographic findings and bleeding outcomes rather than coblation technique.