Endoscopic Grading of Adenoid in Otitis Media with Effusion

INTRODUCTION: Adenoid is thought to be one of the causes of otitis media with effusion, though it is controversial. Grading the adenoid by rigid nasal endoscope in patients with otitis media with effusion may justify adenoidectomy in otitis media with effusion in the future. METHODS: A prospective study was carried out at GMS Memorial Academy of ENT and head neck studies from 15th December 2005-April 2007. Study group comprised of 32 children with otitis media with effusion and control group of 28 children with clinically normal ear and nose. Rigid nasal endoscope was used for grading of adenoid in study and control group. The severity of otitis media with effusion was assessed by preoperative air-bone gap and thickness of the fluid aspirated from middle ear during ventilation tube insertion. RESULTS: In the study group 13 out of 32 had grade 4 adenoid hypertrophy. This grade 4 adenoid hypertrophy was found to be statistically significant in children with otitis media with effusion (P < 0.0002). In control group 15 out of 28 had grade 1 adenoid hypertrophy which was significant in the same group (P < 0.002). Air-bone gap and thickness of fluid did not correlate with the increasing grade of adenoid hypertrophy. CONCLUSIONS: Grade 4 adenoid hypertrophy was statistically found to be significant with otitis media with effusion but severity of hypertrophy were not reflected by hearing loss and thickness of fluid. Keywords: adenoid hypertrophy, myringotomy , otitis media with effusion, ventilaiton tube insertion