The nasopharynx and under-aeration of the middle-ear

[Rhinopharyngitis and recurrent acute otitis media: Risks and guidelines]

Rhinopharyngitis is a common disease in the pediatric population. Acute otitis media is the most frequent complication. Eustachian tube obstruction is responsible for underaeration of the middle-car. Congestion of the respiratory mucosa and adenoid hypertropy result in persistent middle ear effusion and recurrent acute otitis media. Other predisposing factors are allergy, passive smoking, persistent middle ear effusion, young-age at first diagnosis of acute otitis media. Adenoidectomy and/or tympanostomy tubes are indicated in the treatment of recurrent acute otitis media.

Eustachian tube function following adenoidectomy: an evaluation by sniffing

Recent investigations have demonstrated an association between sniff-induced negative middle ear pressure and otitis media with effusion. This is taken as evidence of Eustachian tube malfunction. Adenoidectomy is frequently performed as part of the surgical management for otitis media with effusion, but whether this affects Eustachian tube function is uncertain. The aim of this study was to investigate the hypothesis that if adenoidectomy improved Eustachian tube function, children who had undergone adenoidectomy would show less tendency to generate a high negative intratympanic pressure by sniffing. Eustachian tube function was studied actively in 40 children with otitis media with effusion. Twenty children, selected at random, underwent adenoidectomy and all 40 had a unilateral grommet inserted. Eighty-five percent of the children could create a negative middle ear pressure by sniffing, but there was no difference in the number of 'sniff + ve' children between the adenoidectomy and control groups (P greater than 0.5), or in the magnitude of the negative pressure induced. It is concluded that a high percentage of children with otitis media with effusion are capable of inducing a negative middle ear pressure by sniffing, but this parameter of Eustachian tube function is not affected by adenoidectomy.