A RANDOMIZED CONTROL TRIAL OF ADENOTONSILLECTOMY WITH AND WITHOUT INSERTION OF GROMMET IN TREATMENT OF SECRETORY OTITIS MEDIA

Dr Sanjay Singh; Dr Vikas Kulkarni; Dr Abhay Havle

Volume : VIII, Issue : I, January - 2019

A RANDOMIZED CONTROL TRIAL OF ADENOTONSILLECTOMY WITH AND WITHOUT INSERTION OF GROMMET IN TREATMENT OF SECRETORY OTITIS MEDIA

Dr Sanjay Singh, Dr Vikas Kulkarni, Dr Abhay Havle

Abstract :

Introduction : . Secretory otitis media (SOM) is a pathologic condition of the middle ear in which an effusion is present behind an intact eardrum without signs of acute inflammation. The primary line of management is medical but surgical intervention is needed in refractory and complicated cases. The various surgical treatment options recommended are adenoidectomy, myringotomy, adenoidectomy with myringotomy with or without grommet insertion and occasionally tonsillectomy. The aim of the present dissertation was to evaluate and compare the outcome of adenotonsillectomy with and without insertion of the grommet in the treatment of secretory otitis media.

Material & Methods : A Prospective, Randomized Study conducted at KIMS, Krishna Hospital, Karad after the approval of the institutional ethical committee. The patients attending the outpatient department of ENT which fulfilled inclusion criteria and exclusion criteria, were enrolled. The study period was from December 2016 to June 2018. In this study 48 participants were divided into two groups, Group A is Study group (Adenotonsillectomy with grommet) of 24 cases and Group B is Control group (Adenotonsillectomy without grommet) (24 cases) by using simple random sampling technique, randomisation and allocation into either group was based on random number table. Follow up of study participants from both the groups was done after 6 and 12 weeks respectively and the result was studied.

Results: Majority of the study subjects presented with Retracted TM (70.83% Vs 66.67%), followed by dullness over the tympanic memane (62.5% Vs 70.83%). Air–fluid level and Pneumatic otoscopic findings were rarely observed. Majority of the study subjects presented with bilateral SOM (66.67% Vs 45.83%), followed by right–sided SOM (25% Vs 33.33%) and left–sided SOM (8.33% Vs 20.83%). The study subjects in both the groups presented with B type tympanogram (70.83% in group A and 66.67% in group B), followed by Type C (29.17% in group A and 33.33% in group B). The percentages of Symptomatic relief (95.83% Vs 58.33%) and Air–bone gap < 10 dB (75% Vs 20.83%) was comparatively found better in group A, as compared to group B. The air–bone gaps before and after surgery was compared. We reported that the reduction of mean air–bone gap was more in group A as than group B. The gaps further reduced after 12 weeks of the follow–up. (7.21 dB Vs 15.20 dB)

Conclusion : The management of Secretory otitis media in Group A (Adenotonsillectomy with gommet insertion ) has shown better results as compared to Group B (Adenotonsillectomy without grommet).