Association between Size of Adenoid and Otitis Media with Effusion Among a Sample of Primary School Age Children in Erbil City

Abstract

Background: The pharyngeal tonsil (adenoid) constitutes the upper portion of the Waldeyer’s ring and it is situated at the top of the nasopharynx, next to the auditory tube and choana. Hypertrophy of the adenoids and eustachian tube dysfunction are often considered to be causal factors for otitis media with effusion. There are many methods used to measure the size of adenoid such as lateral soft tissue X-ray of nasopharynx. Objectives: This study aimed to evaluate the grades of adenoidal hypertrophy among schools age children with otitis media and to find of an association between size of adenoid and occurrence of otitis media with effusion. Subjects and Methods: In this cross sectional study, 17 primary schools were visited; all pupils from the first to the sixth year of elementary study were examined in the period from mid-October 2009 to mid-May 2010. A total of 1,035 pupils were interviewed and those with positive findings that suggest otitis media with effusion were referred to the otolaryngology outpatient department to confirm diagnosis using further investigations such as tympanometry; and a pure tone audiometry was also used to assess the hearing threshold. Adenoid size was measured by adenoid/nasopharyngeal ratio on cervical lateral views of simple X-rays. Results: Otitis media with effusion was found in 48 (4.6%) of the studied children. The most common type of tympanometry results seen among the children with otitis media was type B. Grade 3+ adenoid hypertrophy was mainly seen among patients having unilateral and bilateral otits media with effusion, accounting for 16% and 37% of all cases of otits media with effusion accordingly. Type B tympanogram was significantly associated with positive history of oral breathing in the studied children (p value < 0.05). Conclusions: The study concluded that adenoid hypertrophy was associated with otits media with effusion in school age children. The proportion of otitis media with effusion increases with the severity of nasopharyngeal obstruction by adenoid hypertrophy.