Surgical Treatment of Otitis Media with Effusion according to Eosinophilic Count and Radiological Grading of Adenoid Hypertrophy

Otitis media with effusion is one of the commonest chronic otological conditions of childhood. It is often a co-morbidity of allergic rhinitis. The higher incidence of OME in allergic children indicates the role of allergy in otitis media with effusion OME development and relapse. To detect the outcome of different management plans for treatment of otitis media with effusion OME according to Eosinophilic count in blood. Also to detect any correlation between increased Eosinophils in blood and in Adenoid tissue. This study includes 50 children age range 5-15 years with recurrent otitis media with effusion OME despite proper medical treatment for 3 months accompanied by Adenoid Hypertrophy, evaluated clinically for allergic symptoms and signs for categorization either allergic or non. Audiological and radiological assessment confirmed the diagnosis. Laboratory investigations including Eosinophilic count in CBC divided each category into two groups, Groub A included cases with high blood Eosinophilia underwent Adenoidectomy+ Grommet tube insertion. Group B included cases with normal blood Eosinophilic count underwent Adenoidectomy+ Myringotomy only.  Censoriously of middle ear fluid is noted intra-operatively either mucoid or serous. Endoscopic examination of Adenoid intra-operative is done then removed and sent for histopathological examination to detect Eosinophilia in tissue to correlate blood & tissue Eosinophilia. Also. Follow up of each group was done with PTA and tympanometry up to 6 months. Post operative Adenoid tissue examination showed no Eosinophils in tissue of both groups. Recurrence of otitis media with effusion OME occurs in (32.14%) in Group A, all related to cases with +ve allergic signs & symptoms. Also in Group B, recurrence of effusion occurs in (31.94%) ears, (26.38%) related to cases with +ve allergic symptoms and signs and (5.5%) related to cases with -ve allergic symptoms and signs. No significant correlation has been found between blood and Adenoid tissue Eosinophilia. Also, there is no significant correlation between blood Eosinophilia and consistency of middle ear fluid in each group. The present study concluded that no correlation has been found between blood and tissue Eosinophilia as all Adenoid tissues from cases did not have atypical cells like Eosinophils. As regards outcome of surgical operation myringotomy operations are sufficient in patients with normal eosinophil and grommets tube are necessary for patients with high eosinophil in blood. No correlation has been found between type of middle ear effusion and level of eosinophils in blood