A child has Adenoidectomy done but he has effusion in the middle ear. What is the ideal surgical step ?
Ans. is 'a' i.e., Grommet insertion Treatment of serous otitis mediao Following two treatments have been described : -Watchful waitingWatchful waiting is the active monitoring of the condition and hearing in anticipation of spontaneous resolution Guidlines aimed at both primary care and specialist otolaryngologist broadly agree that a watchful waiter periodfor about three months is the initial management of children with serous otitis media. Therefore, unle there are also signs of an infection, most health care providers will not treat SOM at first Instead, they w recheck the problem in 2-3 months. This should be coupled with reassurance that doing nothing is as likely doing something to result in resolution of the SOM and the associated symptoms.SurgerySurgical intervention is recommended when watchful waiting and monitoring of hearing has confirmed failu of resolution of SOM. Following surgical intervention are used commonly : -Myringotomy and aspiration of fluid : -An incision is made in tympanic membrane and fluid aspirated with suction.Grommet (ventilation tube) surgery: - If myringotomy and aspiration combined writh medical measures has not helped and fluid recurs, a grommet is inserted to provide continued aeration of middle ear. This is the most common surgical intervention for SOM. Mostprefered site of grommet insertion is antero-inferior through a circumferential or radial incision.Surgical treatment of causative factor: - Adenoidectomy, tonsillectomy etc.o Medical measures are controversial and involve : -1. Decongestants2. Antiallergic measures3. Antibiotics4. Middle ear aeration Valsalva maneuver, Politzerisation or eustachian tube catheterization. Chewing gum.
Grommet insertion
Mastoidectomy
Tympanoplasty
None