Surgical findings in tympanic cavity of children suffering from otitis media

Abstract

Surgical intervention should be considered when observation and medical therapy fail to demonstrate timely resolution of the effusion. Myringotomy with insertion of ventilation tubes was found by many authors to be most effective in preventing and treating of different forms of OM. The purpose of our research is to describe and compare the surgical findings in children suffering from different forms of OM who underwent Myringotomy with Tympanostomy tubes insertion. The research was carried out in ORL Clinic, Republican Hospital for children “Em. Cotaga”. The study involved 38 patients at the age from 1 mo to 18 years with different forms of otitis media - otitis media with effusion (OME) and recurrent acute otitis media (RAOM) in remission. The Work up included: anamnesis, pneumatic otoscopy, otomicroscopy, conventional audiometry, impedance audiometry otomicroscopy during surgery, examination of surgical findings and analysis of morphological changes in tympanic cavity, cytological and histological results. In additional rhinoscopy, oropharyngoscopy and posterior rhinoscopy were performed. Tympanic membrane (TM) appearance (color, transparency, dullness, opacity, thickness, visibility of main points, presence of retraction pockets, thin-film adhesion, its localization and size) were evaluated by otoscopy before surgery and otomicroscopy during the surgery. Tympanic cavity (TC) changes (presence and character of effusion - serous, mucous, purulent, changes of mucosa - color, thickness, presence of granulation tissue, polyps), etc. were evaluated by otomicroscopy during the surgery. Surgical procedure - Myringotomy was made under general anesthesia with endotraheal anesthetic. From 38 children included in Project 24 were diagnosed as having OME (63.2%) and 14 - RAOM (36.8 %). We have shown that various forms of OM are dynamically interrelated regarding their causes and pathogenesis and do not represent separate entities. Rather, they represent the same disease process as it progresses in continuum. We support the opinion of some authors that TT insertion prevents severe retraction pocket formation and cholesteatoma development. We consider that using tympanostomy tubes for the treatment of otitis media with effusions and recurrent otitis media in childhood might prevent the necessity of early, repeated and radical ear surgery in the future.