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.
