The aim of this study is to clarify the role of peritubal adenoid enlargement in the etiology of ME, otitis media with effusion OME, and if its removal can be sole surgical treatment after failure of medical treatment.
This study includes 100 patients, medical treatment was first given up to two months, OME resolved in 36 patients while 64 did not respond to treatment. They included 46 cases without history of previous surgery (gpI), 18 recurrent cases who underwent previous adenoidectomy , insertion of ventilation tube, and in some cases tonsillectomy, (gpII) each of them were subdivided into two subgroups one treated surgically by adenoidectomy, myringotomy, and insertion of ventilation tube (sub groups A), the other treated by adenoidectomy only (sub groups B), taking care to remove peritubal adenoids carefully using the endoscope.
In recurrent cases, the cause was found mostly due to neglecting removal of peritubal adenoids. Nasal Endoscopy was found to be the most accurate diagnostic tool in such cases. However its use is limited by the cooperation of the young patients.
The result in both sub groups was nearly the same. In group I, (A,B) ; (first time surgery) 100% cure & in group II (A,B); (recurrent cases) 88% cure rate were achieved , so we concluded that proper complete adenoidectomy including peritubal adenoidectomy is very effective to manage primary and recurrent cases of OME even without insertion of ventilation tubes.
The mechanism by which adenoid enlargement cause OME may be due to direct mechanical pressure on the eustaechean tube, acting as a septic focus of infection or through modulating the immune response. |
