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Article
Is Adenoidectomy Enough as a Surgical Treatment for Otitis Media with Effusion Caused by Adenoid Hypertrophy?
هل يكفي استئصال غدة الأدينويد كعلاج جراحي لانصباب الأذن الوسطى الناتج عن تضخم غدة الأدينويد

Author: Mohammad Hassan Al-Baldawi د. محمد حسن البلداوي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2011 Volume: 24 Issue: 1 Pages: 61-65
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background :- Adenoid diseases are one of the major ENT problems in pediatrics that require surgery in high incidence of children especially in primary school as it affects the school performance due to recurrent otitis media & otitis media with effusion with resultant hearing loss. Objectives :-Comparison between adenoidectomy (As) alone & adenoidectomy with myringotomy (Ms) & grommet insertion (Gs) in children with otitis media with effusion ( OME)due to adenoid hypertrophy (AH) describing the results & postoperative complications of each operation in order to get the best helpful surgical method to treat this disease & prevent further episodes. Patients & Methods: - Fourty primary school children enrolled in this study who were attended department of otolaryngology in Al – Yermouk teaching hospital in a period from February 2007 to December 2008. All children have bilateral OME & hearing loss due to AH , they were divided into two groups each with 20 children ( i.e. 40 ears ) & underwent surgery ( the 1st group with As alone & the 2nd one with AsMsGs ) with postoperative follow up for one year by clinical evaluation of the results & postoperative complications. Results :- Postoperative clinical evaluation of both 1st & 2nd groups revealed improvement in 15 (37.5%) & 38 (95%) ears respectively, unilateral improvement encountered in 9 (22.5%) & 18 (45%) ears respectively , while bilateral improvement seen in 6 (15%) & 20 (50%) ears respectively. On the other hand recurrence & failure was seen in 25 (62.5%) & 2 (5%) ears respectively , this recurrence was unilateral in 13(32.5%) & 2(5%) ears respectively & bilateral in 12(30%) & 0 (0%) ears respectively .Recurrence was challenged mainly within 3 months in the 1st group (i.e. short term benefit ) & within 6 months in the 2nd group with longer lasting improvement because the operation include AsMsGs which achieve drainage & ventilation of the middle ear. Postoperative complications are encountered only in the 2nd group with AsMsGs as it utilized MsGs, but these complications are not associated with remote sequelae. Conclusions :- As alone seems to have no postoperative morbidity but with less beneficial results , whereas AsMsGs showed better improvement of hearing & the recurrence rate decreased remarkably as compared with As alone. However, despite Gs had relatively more complications, AsMsGs is strongly advisable than As alone for treating OME due to AH & prevention of its recurrence.Key words: - Adenoidectomy, Otitis Media with Effusion

الخلفية :- تعتبر امراض غدة الادينويد من المشاكل المهمة في الاطفال والتي تحتاج الى تداخل جراحي خاصة في اطفال المدارس الابتدائية كونها تؤثر على الاداء المدرسي للطفل بسبب الالتهابات المتكررة للاذن الوسطى و انصباب الاذن الوسطى مع فقدان السمع .الهدف :- الغاية من البحث هو المقارنة بين استئصال غدة الادينويد لوحدها وبين استئصال الادينويد مع بزل طبلة الاذن الوسطى مع وضع انبوب التهوية للاطفال المصابين بأنصباب الاذن الوسطى بسبب تضخم غدة الادينويد حصريا لايجاد افضل طريقة جراحية لعلاج المرض ومنع تكراره .طريقة البحث :- هذا البحث هو دراسة مستقبلية أجريت في مستشفى اليرموك التعليمي للفترة الممتدة من شباط 2007 وحتى كانون الاول 2008 , وقد شمل البحث 40 طفلا بأعمار 6 – 12 عاما . لقد اختير الاطفال المصابون بأنصباب الأذن الوسطى في كلا الاذنين الناتج عن تضخم غدة الادينويد , وتم تقسيمهم الى مجموعتين من 20 طفلا (40 اذنا ) وكل مجموعة اجريت لها احدى العمليات موضوع الدراسة . تم دراسة المجموعتين من خلال متابعة النتائج والمضاعفات مابعد العملية . النتائج :- اظهر لنا التقييم السريري بعد العملية للمجموعتين وجود تحسن كبير في السمع بنسبة 5,37 % و 95% على التوالي , بينما تبين ان ضعف السمع قد تكرر بنسبة 5,62 % و 5% على التوالي . كما ان نسبة الفشل ظهرت بشكل رئيسي خلال 3 اشهر في المجموعة الاولى وخلال 6 أشهر في المجموعة الثانية . اما المضاعفات مابعد العملية فقد ظهرت في المجموعة الثانية فقط ولكنها لم تؤدي الى مشاكل مستقبلية . الاستنتاج :- بعد دراسة النتائج استطعنا الأستنتاج بأنه برغم الوجود النسبي للمضاعفات بعد العملية في المجموعة الثانية الا ان نتائج العملية كانت جيدة جدا بالمقارنة مع المجموعة الأولى فيما يخص ضعف السمع وهو السبب الذي من اجله تم اقرار العملية . كما لوحظ ان بعض هذه المضاعفات بسيطة ويمكن معالجتها وبعضها الاخر لايمكن التنبؤ بحدوثه فيما لم تحصل اطلاقا اية مضاعفات خطيرة ومؤثرة , لذلك كانت التوصية بالعملية الثانية لأن الجراح يتمكن من تلافي الكثير من هذه المضاعفات غير الخطرة للحصول على النتائج المنشودة .


Article
The Effect of Amoxicillin-Clavulanate and Actifed Versus Actived Only in treatment of Otitis Media with Effusion

Authors: Ahmed Muhei Rasheed*,FIBMS(Otolaryngology) --- Yusra Hayder Taha**, FICMS(Otolaryngology احمد محي رشيد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2008 Volume: 50 Issue: 3 Pages: 327-331
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Otitis media with effusion(OME)is a common cause of deafness in childrenwith subsequent impairment of speech development and scholastic difficulties.Treatmentremains controversial.Aim: To study the effect of amoxicillin-clavulanate in treatment of OMEPatients and methods: A prospective study of a target sample consisting of sixty childrenunder the age of 12 years presented with chief complaints duration for at least 6 weeks andon examination there were bilateral red and retracted tympanic membranes withoutoversized adenoids and no underlying causes require surgical correction e.g cleft palate.Thepatients were divided into two groups;group A which received Actifed for 4 weeks andgroup B which received Actifed +Amoxicillin-clavulanate for 4 weeks treatmentcourse.After complete history and otolaryngological examination,all the patients were sent tox-ray of postnasal space( to exclude oversized adenoids),audiometry andtympanometry.Assessment was repeated at the end of 2 and 4 weeks of treatment courseincluding audiometry and tympanometry.The response to treatment in group B wascompared to that in group A at the end of 4 weeks treatment course.In this study,we referedto improvement in otoscopic findings and tympanometry results to show the response to 4weeks treatment course.Results: Eight patients(25.81%)in group A have shown response to treatment at the end of 4weeks treatment course,while the response in group B was seen in 15 patients( 51.72%).Conclusion: Amoxicillin-clavulanate has statistically significant effect in treatment of otitismedia with effusion(OME)in short term follow-up and the clearance of middle ear efussionin response to amoxicillin-clavulanate indicates that bacterial infection may play a role in theaetiology of OME.Keywords: Otitis media with effusion,Amoxicillin-clavulanate,Tympanometry.


Article
PREVALENCE AND RISK FACTORS OF OTITIS MEDIA WITH EFFUSION IN SCHOOL AGE CHILDREN

Author: Hayder S Atwan*, Ahmed A Alansary**, Abdulwahab B Abdulwahab@& Abdul-Razzaq H Alrubaiee#
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2016 Volume: 22 Issue: 1 Pages: 25-32
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Otitis media with effusion, which refers to the accumulation of fluid in the middle ear cavity without any signs of infection, is a common health problem both in pre-school and school age children. The etiology of otitis media with effusion is multifactorial and many risk factors may increase its incidence. The aim of this study is to determine the frequency and risk factors of otitis media with effusion in school age children in Basrah. In this descriptive prospective study; sixty patients aged between 6-12 years were included; they were 34 males and 26 females diagnosed as having otitis media with effusion in the period between July 2013 to April 2014; at Basrah General Hospital, Iraq. Pure tone audiometry, tympanometry, and lateral x-ray film of post nasal space were done for each patient after a full ENT history and examination . A questionnaire form was constructed to apply for each patient including the possible risk factors for developing otitis media with effusion such as age group, gender, parental smoking, allergy, history of acute infection, maternal education, family income, school type. Otitis media with effusion was found to be higher (66.7%) in children aged between 6-8 years, males more than females with male to female ratio 1.3:1. (61.6%) were from rural area, parental smoking present in (65%), (58.3%) had history of allergy, (66.6%) with history of upper respiratory tract infection, low maternal educational level, low financial income (66.6%), attendance to public school, and the presence of adenoid hypertrophy (71%) were found to be associated with otitis media with effusion. Conclusion and Recommendation: Environmental, epidemiologic and familial factors play an important role in etiology of otitis media with effusion. The parents must be informed about these modifiable risk factors, by this way the development or delayed diagnosis of the disease that may cause serious consequences can be prevented.


Article
Frequency of Otitis Media with Effusion in Children with Adenoid Hypertrophy
مدى الاصابة بالتهاب الاذن الوسطى مع انثقاب الطبله عند متضخمي العقد اللمفاويه للتجاويف

Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2017 Volume: 30 Issue: 2 Pages: 95-100
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:Background: Otitis Media with Effusion (OME) is a chronic accumulation of mucous within the middle ear , and sometimes the mastoid air cell system .Objective: To study the frequency of otitis media with effusion in relation to the effect and size of adenoid hypertrophy as an aetiological factor , in addition to others like presenting symptoms, risk factors and the changes of tympanometry in otitis media with effusion.Patients and methods: A cross sectional study for 12 months (January 2011-january 2012) in Al-Yarmouk Teaching Hospital, ENT department. One hundred children with adenoid hypertrophy aged (3-12years) were included. All of them were evaluated by clinical ENT examination, tympanometry and lateral plane x-ray of nasopharynx to assess the size of hypertrophied adenoid and classified into 3 grades (I, II and III) and asses the frequency of otitis media with effusion in each grade.Results: Only 38 children out of one hundred (38%) were diagnosed as having otitis media with effusion; with 26 patients were bilaterally involved (68.5%) and 12 patients were unilaterally involved (31.5%). According to adenoid grade, the incidence of otitis media with effusion was as follow: grade I: 19 patients (38ears) only 7 ear with effusion (18%) , grade II : 47 patients (94ears)only 26 ear with effusion (27%) and grade III : 34 patients (68 ears) only31 ears with effusion (45%). Type B tympanometry was more in grade III adenoid hypertrophy 47%.Conclusion and Recommendation: The frequency of otitis media with effusion is directly proportional to the size of adenoid. It is recommend that early diagnosis and proper management of adenoid hypertrophy to reduce the incidence of otitis media with effusion and its sequels of hearing loss and poor speech development in children .


Article
Incidence of otitis media with effusion in children with adenoid hypertrophy
نسبة حدوث التهاب الأذن الوسطى مع الانصباب عند الأطفال الذين يعانون من تضخم غداني

Authors: Lana Sh. Dabbagh --- Farhad J. Khayat
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2011 Volume: 15 Issue: 2 Pages: 57-63
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objectives: Otitis media with effusion is collection of fluid behind intact tympanic membrane. Otitis media with effusion usually coexists with the adenoid hypertrophy. The adenoid is a part of Waldeyer's ring; its basic function is thought to be antibody production. The aim is to identify the incidence of otitis media with effusion in children with adenoid hypertrophy.Methods: A prospective descriptive cohort study had been employed at Rizgari Teaching Hospital/ Erbil from January 2008 to July 2008. Summation of total 120 Child aged 3-12 years old were being conducted in the survey. All patients subjected for history, local physical examination, Information's recorded on a specially designed Questionnaire and proper investigations were done including lateral X ray of post nasal space, and audiological examination.Results: Among 120 patients age (3-12) years old with adenoid hypertrophy, 44 patients (36.7%) had OME, mean age was 6.5 years. Most common age group was (5-6) years (21) (47%).Conclusion: Adenoid Hypertrophy (AH) can be relevant in the pathogenesis of otitis media with effusion (OME) due to its anatomic position.


Article
Prevalence of otitis media with effusion among preschool-age children in Erbil governorate
انتشار التهاب الأذن الوسطى لدى الأطفال في سن ما قبل المدرسة في محافظة أربيل

Authors: Arsalan Awlla Mustafa Shem --- Zhwan Maghdid Aziz Koye
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2018 Volume: 22 Issue: 3 Pages: 282-291
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Otitis media with effusion is one of the common diseases in children at preschool age. This study aimed to determine the prevalence of otitis media with effusion in Erbil governorate and compare this prevalence by urban and sub-urban areas and by different seasons.Methods: This descriptive cross-sectional study was carried out in the Department of Otolaryngology, Rizgary Teaching Hospital from April 2015 to May 2016 through enrolling1077 children from randomly selected kindergartens.Results: Of 1077 children, 124 were diagnosed as otitis media with effusion and the prevalence was 11.5% in Erbil governorate. The highest rate of otitis media with effusion was seen in spring (17.3%), followed by winter, autumn and summer (15.3%, 10.8%, and 4.3%, respectively). The prevalence of otitis media with effusion was higher in the sub-urban areas (13.8 %) compared with urban areas (10.7 %).The prevalence of otitis media with effusion was higher among male children (13.4%) than female children (9.4%). The highest proportion of diagnosed otitis media with effusion was among four years old children (13.6%), followed by five and six years old (10.5% and 7.7%, respectively). History of repeated upper respiratory tract infection and snoring were the most common risk factors seen in the child with otitis media with effusionin the rate of 70.2% and 69.4%, respectively.Conclusion: The prevalence of otitis media with effusion among preschool-age children in Erbil governorate was 11.5% with a maximum prevalence of 17.4% in the spring season.


Article
Tympanostomy Tube Complication in Otitis Media with Effusion

Authors: Ghassan Hassan Rahim --- Mohammed Rahim Ali
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2019 Volume: 15 Issue: 2 Pages: 58-61
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Otitis media with effusion is characterized by accumulation of fluid in the middle ear in absence of acute inflammation and it is the most common cause of acquired hearing loss in children, and may negatively affect language development failure of medical treatment of middle ear effusion frequently require myringotomy and tympanostomy tube insertion.Objectives: To determine tympanostomy tube complications of tube in children with chronic otitis media with effusion who were treated with Shah Grommet tube insertion.Methods: The Medical records of 162 ears of 87 children (52 male and 35 female) were reviewed respectively, the patients ages were between 3 to 16 years old (mean age =8.11 years), patient were followed for 6-66 months (mean 23.3) after tympanostomy tube insertion. Tube extrusion time was also reviewed in all patients, and the indication for surgery was chronic middle ear effusion.Results: Otorrhea accured in nine ears (5.6%), granulation tissue was seen in 2 ears (1.2%), myringosclerosis in (34.6%) persistent perfor-ation (5.6%), atrophy (23.5%) retraction (16.7%) and medial displacement 1.2% the average extrusion time was 8.5 month ( ± 4.6).Conclusions: complications of tympanostomy tube insertion are common and the most common are otorrhea myringosclerosis, atrophy but they are generally insignificant consequently in majority of these complications there is no need for management.


Article
CLINICAL AND TYMPANOMETRIC ASSESSMENT OF MIDDLE EAREFFUSION VERSUS MYRINGOTOMY FINDING

Authors: Mazin N. Fatoohi --- Hani Musa Bader --- Hamed M. Mohammed
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2008 Volume: 50 Issue: 3 Pages: 321-326
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The present study was planned to show the accuracy of clinical examination and
tympanometry in diagnosis of middle ear effusion.
Patients and Methods: The study involved 80 patients (160 ears )suspected to have otitis media
with effusion (OME) from different age groups ; 56 were males and 24 were females .
Clinical assessment for all patients included otoscopy , pneumatic otoscopy and audiological
assessment by using pure tone audiometry and tympanometry then comparing the results to
findings at myringotomy as the gold standard for presence or absence of fluid in the middle ear .
Results : Fluid whether serous or glue was found in 100 ears ( 62.5 %) where as sixty ears were
dry, sensitivity , specificity and accuracy of tympanometry were 90 % , 70 % and 85 %
respectively , and for clinical assessment were 82 % , 52% and 71 % respectively . A combined
clinical and tympanometry sensitivity and specificity were calculated and found to be 96 % and
92 % respectively.
Conclusion : clinical examination as a method for diagnosis of middle ear effusion depend on
experience of the examiner . tympanometry proved to be a reliable diagnostic tool for the
diagnosis of OME , it appeared significantly better at determining non effusion state.


Article
Adenoidectomy with Myringotomy and Tympanostomy Tube Versus Adenoidectomy with Myringotomy in Treatment of Otitis Media with Effusion in 5-7 Years Old Children

Author: Dr. Ahmed Muhei Rasheed
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2016 Volume: 12 Issue: 1 Pages: 83-86
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Adenoiditis is a common cause of otitis media with effusion (OME) in children & perhaps OME is one of the most common diseases leads to hearing impairment in children with subsequent impairment of speech development & learning difficulties , however, treatment remains controversial. Objectives: To evaluate if there is a significant advantage of tympanostomy tube insertion in association with adenoidectomy over adenoidectomy in association with myringotomy alone in treatment of children with OMEType of the study: This is a prospective study. Patients & methods: The study consisted from 63 children diagnosed as cases of bilateral OME & variable degrees of adenoid hypertrophy. The patients were divided randomly into two groups, group A (32) were subjected to adenoidectomy & myringotomy with tympanostomy tube insertion & group B (31) were subjected to adenoidectomy & myringotomy alone. Pure tone hearing threshold was measured preoperatively & at the 3rd month and 6th month postoperatively. Statistical analysis is done to compare the means of pure tone hearing threshold between group A & B. Results: The mean pure tone hearing threshold preoperatively in group A was 28.3 dB, while it was 27.9 dB in group B. Three and six months postoperatively the means in group A were 13.2 dB and 6.8 dB respectively , while the means were 19.4 dB and 13.6 dB respectively in group B. Statistical analysis showed statistically significant difference between the means of pure tone hearing thresholds in both groups during the whole follow up period (P value less than 0.05). Conclusion: There is statistically significant advantage of tympanostomy tube insertion in association with adenoidectomy compared to adenoidectomy with myringotomy alone in treatment of OME in term of hearing level.


Article
Efficacy of Intranasal Beclomethasone in the Treatment of Children with Otitis Media with Effusion and/or Adenoid Hypertrophy

Author: Firas Baheej Abdul Aema*, Hassan Mohammed Abbas Al-Timim
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 2 Pages: 176-183
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Adenoid hypertrophy and otitis media with effusion are very frequent indications for surgery in children. Otitis media with effusion is the commonest cause of their hearing difficulty.A potential role of corticosteroids in the treatment of both diseases has emerged "6". Short-term use of systemic steroids provides a temporary improvement but long-term use of systemic steroids is not appropriate in children due to severe side-effects. On the other hand, topical nasal steroids without systemic side-effects might be used"7" .OBJECTIVE:To prove that intranasal steroid treatment can be a useful alternative to surgery in the treatment of children with otitis media with effusion and/or adenoid hypertrophyPATIENTS AND METHODS: A total of 68 children (4–14-year-old) on the waiting list for an adenoidectomy and/or myringotomy with or without ventilation tube placement were enrolled into the study and control groups. The study group (38 patients with adenoid hypertrophy, 19 of them with otitis media with effusion) received intranasal beclomethasone dipropionate (aqueous suspension) 168 mcg daily, and the control group (30 patients with adenoid hypertrophy, 16 of them with otitis media with effusion) was followed up without any treatment. All patients were evaluated at 0 and 8 weeks. The assessment of each patient included history, a symptom questionnaire, a tympanogram, a pure tone audiogram, and otoscopic examination and a plain radiograph (lateral soft tissue X-ray of postnasal space). The size of adenoid tissue was graded as a percentage according to obliteration of the airway of the postnasal space. The adenoid/postnasal (A/P) airway ratio was recorded for each patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2 (continuous). The data were analyzed with the “Statistical Package for the Social Sciences” (SPSS 9.0).RESULTS:Resolution of otitis media with effusion in the study group (41.6%) was significantly higher than that in the control group (13.3%) (p < 0.001). Twenty -six patients (68.4%) with adenoid hypertrophy in the study group showed a significant decrease in adenoid size according to the plain radiograph evaluation compared to the control group (p < 0.001). A significant improvement in obstructive symptoms was seen in the study group (p < 0.001). The radiographically measured adenoid/postnasal airway ratio and degree of obstructive symptoms showed a significant correlation (r = 0.838 p < 0.001, r = 0.879 p < 0.001, r = 0.838 p < 0.001, r = 0.879 p < 0.001). CONCLUSION: Nasal beclomethasone dipropionate treatment can significantly reduce adenoid hypertrophy and eliminate obstructive symptoms. It is a useful alternative to surgery (in good percentage of cases), at least in the short term (8weeks ), for otitis media with effusion.

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