Therefore, this prospective study was planned with a specific objective to evaluate the effect of adenotonsillectomy in treatment of recurrent secretory otitis media in children and the evaluation of its effect on hearing with ASSR. On searching the english literature, we couldn't find any published study assessing the changes in ASSR post adenotonsillectomy in OME. The gain in hearing can be quantified by a post operative ASSR. Post adenotonsillectomy there is an improvement in Eustachian tube function and reduction in middle ear effusion. ASSR being an objective test, can be easily used in infants and children while they are sedated or asleep to assess the degree of hearing loss. However, PTA being a subjective test fails to provide adequate assessment in very young children.Īuditory steady-state response (ASSR), a newly developed objective auditory evoked potential test predicts frequency specific hearing threshold in all patients irrespective of age, mental state, and the degree of hearing loss. A comparison of thresholds measured by air conduction (AC) and bone conduction (BC) provides separate estimates of the status of conductive and sensorineural systems. Pure tone audiometry (PTA) has been the gold standard for the evaluation of hearing level. Other abnormal tympanometric curves including type C and As may also be seen in OME. OME commonly presents with a type B curve i.e, a flat curve with no compliance peak. Tympanometry is a noninvasive test used for measuring middle ear pressure. Increased pressure can also cause a bulging TM. Local symptoms and signs include hearing loss, feeling of fullness in the ear, a 'popping' sensation and a dull retracted tympanic membrane (TM) with restricted mobility on saegalisation often with air bubbles behind the TM. Enlarged adenoid causes tubal obstruction at its nasopharyngeal opening and causes reduction of middle ear pressure and compliance towards negative side due to absorption of gas which leads to otitis media with effusion. The normal middle ear pressure is -100 mm of H 2O to + 50 mm of H 2O and the normal middle ear compliance is 0.39 ml to 1.30 ml. The classical concept is that enlarged adenoid or recurrent infection of adenoids causes recurrent acute otitis media and OME. Enlarged adenoids block the eustachian tube causing conductive hearing loss. Symptoms due to adenoid and tonsillar hypertrophy include nasal obstruction, snoring, mouth breathing and hyponasal speech. The main reasons postulated for adenotonsillectomy as a means of treatment and prevention of recurrence have centred on the size of the adenoids and the role of recurrent tonsillitis as a focus for ascending eustachian tube infection. Allergy of the upper respiratory tract may also contribute to enlarged adenoids. Recurrent attacks of rhinitis, sinusitis and chronic tonsillitis may cause chronic adenoid infection and hyperplasia. Adenoid hypertrophy is an important etiological factor in the causation of OME. It is the leading cause of hearing loss and a social morbidity in children which has long-term consequences for speech and language development. Otitis media with effusion (OME) is an important and common condition in paediatric age group.
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