Prognosis Of Pediatric Otitis Media With Effusion After Adenoidectomy

Objective: To explore the effective rate of pediatric otitis media with effusion (OME)after adenoidectomy (AD) through clinical retrospective study. The cases weresatisfied concurrently adenoid hypertrophy（AH）and OME and were devided byAcoustic impedance(AI). In order to study the feasibility that pure adenoidectomy(AD) treat pediatric otitis media with effusion. Meanwhile to describe relation of thedifferent recovery rates to the "self-healing" time after adenoidectomy. In order toprovide date that the patients can get the best recovery and the time oftympanostomy tube for invalid cases. As a reference of clinical standardizedtreatment of pediatric OME.Methods: Collected the cases conformed to diagnostic criteria of AH and OMEcoinstantaneously in otolaryngology department of the second affiliated hospital ofDalian medical university from June2012to June2013. The48cases were selected.“B” type,“C” type and “As” type were classified by tympanogram, the "SC normalgroup" and "SC reducee group" were divided by acoustic compliance values, the“ASR increased group” and “ASR not elicited group” were sorted by acousticstapedius reflection (ASR). Then they did get the adenoidectomy of low temperatureplasma ablation by nasal endoscopy, and followed up6month after surgery. Theprognosis is divided into the cured group, the valid group and the invalid group. Putthe cured group as the termination of the follow-up. To analyse statistically theeffective prognosis rate of each group in tympanogram, SC and ASR and the totaleffective rate. In order to investigate the efficacy of OME and the recovery degree of ossicular chain mobility and acoustic sensitivity in children AH with OME afteradenoidectomy. At the same time, to analyse statistically the relation of theconvalescent periods of OME to different "self-healing" rate. To study the bestperiod of prognosis and tympanostomy tube time for invalid cases afteradenoidectomy. The t-test or chi-square test for statistical analysis were applied onthe survey data respectively by using SPSS19.0software.Results: Through postoperative follow-up, on3month after adenoidectomy, the typeof tympanogram of pediatric AH with OME showed type B, type C, type As, andcorresponding effective rate was82.5%,92.3%and66.66%. Typing by SCV,（0.41±0.38）ml VS(1.01±0.36）ml corresponded to the preoperative and postoperativeSC in "SC normal group". the effective rate was100%.（0.14±0.12）ml VS(0.69±0.31）ml corresponded to the preoperative and postoperative SC in "SC reduceegroup". the effective rate was83.3%. compared statistically before and afteroperation data respective between normal group and reduced group, Tnormal=-4.233，Treduced=-11.320，（P＜0.05）。Postoperative comparison between normal group andreduce group, T=13.15,（P <0.05)。Typing by acoustic stapedius reflection, theeffective rate was100%in “ASR increased group” and was82.81%in “ASR notelicited group”. the total effective rate equal to84.7%on3months afteradenoidectomy.type B, type C, type As correspond to the effective rate of95.0%,100%and83.33%for pediatric OME on postoperative6months. the postoperative SC was(1.01±2.79）ml in the normal group. the effective rate was100%. the postoperativeSC was (0.91±0.29）ml in the reduced group. the effective rate was95.45%. thepostoperative3month and6month data was compared between the normal groupand reduced group. Tnormal=-0.033，（P＞0.05), Treduced=-17.828，(P＜0.05)。Postoperative comparison between normal group and reduce group, T=0.88,（P＞0.05)。the effective rate between “ASR increased group” and “ASR not elicitedgroup” was（100%VS95.3%）respectively. After6months of postoperation, the totalefficiency equaled to95.83%. The total effective rate were22.22%VS36.11%VS84.7%VS95.83%corresponding1week,1month,3months and6months after AD. The total periodeffective rate of after1week,1week to1month,1month to3months and3monthsto6months was respectively22.22%VS13.89%VS48.59%VS11.13%. Prognosticefficient rate of postoperative3month and6month worked out statisticallysignificant discrepancy P＜0.05.Conclusions:1:For pediatric AH with OME, the majority of OME can self-heal inthe short term (three months) after adenoidectomy It is not recommended thatadenoidectomy were performed concomitantly with myringotomy with grommetinsertion.2:For pediatric AH with OME after adenoidectomy, postoperative1~3months was the optimum recovery period for children OME, but there were stillsome cases can present advantageous prognosis on3~6months period after AH.Recommended that intervention time of myringotomy with grommet insertion forinvalid cases should be6month after AH.