الفهرس 
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Abstract
Otitis Media with Effusion (OME) is defined as the presence of middle ear fluid in the absence of symptoms of acute infection (fever and otalgia). It is associated with conductive hearing loss and an increased risk of acute otitis media. It leads to complications such as hearing loss, damage to the tympanic membrane (atrophy, retraction pockets, and cholesteatoma), delayed language development, and behavioral disorders.
Management of OME consisted of many choices, including auto inflation and medical treatment, which included antibiotics, mucolytics, and corticosteroids. Surgery was indicated in cases where the effusion does not resolve spontaneously or has failed medical treatment for 3 months. The main purpose of surgery was to restore middle ear aeration by eliminating negative intratympanic pressure, so the mucosa was normalized, the number of hair cells increased, and the secretion potential was reduced.
The adenoid may play an important role in the pathogenesis of OME; adenoid hypertrophy can cause mechanical obstruction of the Eustachian tube. The adenoid may be the source of bacterial infection, which can induce inflammation of the middle ear mucosa and may provide a microenvironment for the generation of T lymphocytes. When chronic adenoid infection is suspected, adenoidectomy is being increasingly used for the treatment of OME.
The ventilation tubes of the ear were tiny cylinders placed through the ear drum to allow aeration of the middle ear. Myringotomy with ventilation tube placement remains the most common surgical procedure in the treatment of OME.
This study aimed to compare the fate of secretory otitis media in patients with adenoids hypertrophy undergoing adenoidectomy alone, with myringotomy, or with tympanostomy tube application.
A total of 150 patients suffered from persistent OME due to adenoid enlargement and were divided randomly into three groups as follows: group I consisted of 50 patients who had adenoidectomy alone. group II consisted of 50 patients who had adenoidectomy and myringotomy. 50 patients in group III underwent adenoidectomy and ventilation tube insertion and the SPSS_22 software package was used to analyze the data.
The enrolled patients were divided into two groups based on where they lived: 97 lived in rural areas and 53 lived in urban areas. According to gender, patients were classified into 85 males and 65 females. Patients were classified according to age into three classes: <4: less than four years old (43), 4-8: between four and eight years old (67), and >8: more than eight years old (40). 84 patients had associated chronic tonsillitis, and 66 did not.
The results of the tympanogram after six months of healed myringotomy were significantly improved in group III compared to group I compared to group II, as evidenced by the fact that there were 40 (80%) cases with type A tympanogram in group III compared to 13 (26%) in group I compared to 9 cases (18%) in group II. Significant differences existed between groups.
Regarding residence, 39 cases living in rural areas showed improvement on the tympanogram compared to 23 cases living in urban areas. In terms of gender, 34 men and 28 women improved. According to whether or not tonsillectomy was performed, 35 cases had tonsillectomy, compared to 27 cases that did not have tonsillectomy and were cured. All these results were statistically insignificant.
According to age class, 18 cases <4 years old, 23 cases between 4 and 8 years old, and 21 cases >8 years old were cured, and these differences were statistically significant
Below the age of 4 years, 13 (100.0%) cases in group III cured relative to 3 (16.7%) cases in group I and 2 (16.7%) cases in group II, and these differences were statistically significant. Between the ages of 4 and 8 years, 16 (66.7%) cases in group III were cured compared to 6 (30.0%) cases in group I and 1 (4.3%) case in group II, and these differences were statistically significant. Above the age of 8 years, 11 (84.6%) cases in group III cured relative to 6 (40.0%) cases in group II and 4 (33.3%) cases in group I, and these differences were statistically insignificant.
We concluded that below the age of 4 years, clinicians may perform adenoidectomy as an adjunct to TT insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction); otherwise, myringotomy and TT application are sufficient. While Above the age of 4 years, adenoidectomy and TT insertion have the best results regarding improvement of middle ear aeration, Eustachian tube function, hearing level, and the need for tube re-application. But it has some complications, such as persistent perforation, tympanosclerosis, and otorrhea.