الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 109 |  |  |
| | | from | 109 | | |
Abstract
Summary
OME is defined as ‘‘ an inflammation of the middle ear with a collection of liquid in the middle ear space. The signs and symptoms of acute infection are absent, and there is no perforation of the TM’’.
Fluid in the middle ear is most often associated with and is a defining feature of OME. The amount and nature of fluid found in OME is highly variable. The tympanomastoid compartment may be partly or completely filled with fluid, and the fluid can be serous, mucoid or glue like.
Tympanometry has been the established, standardized procedure for diagnosing non-inflammatory MEE for decades. In general MEE is assumed if a curve type B according to Jerger scale, results from the tympanogram.
Evaluation of the patient with OME included history, complete ENT examination and tympanometry for establishing diagnosis of OME. Those with type B tympanogram and failed to respond to medical treatment for 3 months were subjected to myringotomy under general endotracheal anesthesia, and the middle ear fluid was aspirated into an insulin syringe mounted on the aspiration cannula with care not to include blood of myringotomy incision. The viscosity of the fluid was evaluated objectively to add to the subjective surgeon’s opinion. 0.2 ml of the aspirated fluid was applied to the center of a filter paper and left flat for 5 minutes inside a glass container to allow for diffusion of fluid contents of the aspirate. Then, the diameter of the diffusion circle was measured in mm. Similarly, 0.2 ml of water and of aspirated nasal mucus in normal volunteers were applied to filter papers to measure the diameter of diffusion circles of both as control. The mean water diffusion diameter is taken as a control reference of serous MEE, and the nasal aspirate diffusion diameter is taken as a control reference of mucoid MEE.
At myringotomy, the aspirated fluid from the middle ear cavity was mucoid in 38 ears (36.5%), glue in 34 cases (32.7%), and serous in 18 ears (17.3%). There was no fluid in 14 ears (13.5%).
In patients with bilateral OME, the character of the aspirated fluid was the same in both ears in 32 cases (78%) and was different in 9 cases (22%).
The shape of type B tympanogram was either flat in the larger percentage of cases (74/104=71.2%) or peaked in the remaining ones.
In our study, we found tympanometry to be an accurate tool in assessing patients for the presence of fluid in a pre-operative setting that confirmed at surgery in 90/104 (86.5%) ears, while in 14/104 (13.5%) we failed to detect middle ear fluid.
There was a high statistically significant correlation between the type of secretions and the shape of tympanometry. On the other hand, there was a high statistically significant correlation between the type of secretions and the character of tympanometry (gradient and compliance) which means that when compliance decreased and gradient increased, the secretion will be more viscous.
Conclusion
● The type B tympanogram is an excellent indicator of the presence of MEE.
● The pattern (straight or rounded) of the type B tympanometry can propose clinicians to predict the status of the middle ear fluid.
● The compliance and the gradient of the type B tympanometry were strongly correlated with the viscosity of the middle ear fluid.
Recommendation
● Pay attention to the middle ear to exclude possible OME in all children suffering from snoring/nasal obstruction, even if not complaining of diminution of hearing. ● Tympanometry is performed on the day of admission in all children admitted for grommet surgery. ● Rounded type B tympanogram provides very strong evidence that there is a low viscosity MEE. ● Flat type B tympanogram is very likely associated with a high viscosity MEE and surgery should proceed.