CHANGES IN MIDDLE EAR FUNCTION POST ADENOIDECTOMY IN CHILDREN WITH ADENOID HYPERTROPHY
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Keywords
Adenoid hypertrophy, Eustachian tube dysfunction, Middle ear function, Tympanometry, Pure-tone audiometry, Pediatric hearing loss.
Abstract
Background: Adenoid hypertrophy (AH) is one of the common causes of “Eustachian tube (ET) malfunction and upper airway obstruction” in children, which often results in conductive hearing loss, recurrent ear infections, and chronic otitis media with effusion (OME). A recognized surgical procedure for nasopharyngeal blockage is adenoidectomy; however, its exact impact on middle ear function is still being researched. In order to maximize patient outcomes, it is essential to comprehend the postoperative changes in middle ear pressure and effusion resolution.
Objectives:1) To determine the degree of adenoid hypertrophy and changes in middle ear function in children by using tympanometry before adenoidectomy. 2) To analyze the changes in middle ear pressure using tympanometry preoperatively, 1 week, 3 weeks, and 6 weeks postoperatively after adenoidectomy in children with adenoid hypertrophy.
Methodology: A prospective observational study was conducted in the Department of ENT at Adichunchanagiri Institute of Medical Sciences, BG Nagara from July 2023 to January 2025 over a duration of 18 months. Pediatric patients aged 5–12 years diagnosed with grade 3 and 4 adenoid hypertrophy, with or without concurrent OME, undergoing adenoidectomy. A comprehensive preoperative assessment included otoscopic examination, pure tone audiometry, and impedance audiometry, with tympanometry, as the primary tool for assessing middle ear function. Tympanometry measurements were recorded preoperatively at 1, 3, and 6 weeks postoperatively to observe changes in middle ear functioning. Data were analyzed using SPSS software, employing paired t- tests for statistical comparison, with p<0.05 considered statistically significant.
Results: Preoperative tympanometry demonstrated middle ear dysfunction in 90% of patients, with “60% exhibiting Type B curves, 30% exhibiting Type C curves, and only 10% having Type A (normal) tympanograms”. Post-surgery, tympanometry patterns substantially improved, with “30% of ears normal by week 1, 60% by week 3, and 85% by week 6”. The audiometric evaluation exhibited a gradual lowering in hearing thresholds, with preoperative mean PTA values of “30 dB HL in the right ear and 28.75 dB HL in the left”. Hearing improved marginally after the first postoperative week, and by the third week of recovery, mean thresholds had decreased to 20 dB HL (left) and 22.5 dB HL (right). Hearing levels were close to normal by six weeks, with final values of 15 dB HL (left) and 17.5 dB HL (right). Notably, 12 patients with higher grades of adenoid hypertrophy (Grade 4) exhibited more severe preoperative hearing loss but showed the most significant postoperative recovery.
Conclusion: Most children restore near-normal middle ear function and hearing within six weeks of surgically treating adenoid enlargement, leading to a gradual improvement in tympanometry profiles and audiometric thresholds. To prevent long-term conductive hearing loss and its potential impact on speech and cognitive development, research findings emphasize the need of early detection and treatment of adenoid hypertrophy.
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Dr. Sumayya Fatima
MBBS, Resident, Department of ENT & HNS. Postgraduate Student, Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Karnataka, India
Dr. RAVI K.S
MBBS, MS (ENT), MBA, DHM Professor, Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Karnataka, India.
Dr. Kiran T
Assistant Professor, Adichunchanagiri institute of medical sciences
Dr. Nishant Gupta
Junior Resident, Adichunchanagiri institute of medical sciences