AIIMS May 2007 MCQ ENT Answer 2

The Correct Answer is B

A grommet is a small bobbin-shaped tube used to keep open the incision made in the ear drum as a ventilation of secretory otitis media. It acts as a ventilation tube by allowing the Eustachian Tube to recover its normal function.

A period of watchful waiting is the best management strategy for children with otitis media with effusion. Grommets should only be considered for patients satisfying defined criteria. Patients and parents should be advised of the risk of potential harm e.g. tympanosclerosis.

Children with hearing impairment should have a period of at least 6 months of watchful waiting from the onset of the symptoms.

Grommet should only be considered if
A - glue ear persists, and the child (3 years or over) also suffers from one of the followings:

1. Recurrent acute otitis media with more than 5 times per year.
2. Evidenced delay in speech development
3. Educational or behavioural problems attributable to persistent hearing impairment, with a hearing loss of at least 25dB particularly in the lower tones (low frequency loss
4. A second disability, such as Down’s syndrome
5. Severe collapse of the eardrum

Or

B. the child has had at least 5 occurrences of acute otitis media in the last year with additional complications such as perforations, persistent discharge, febrile convulsions, sensorineural deafness or cochlear implantation.

Or

C. for children aged 2 years, the child has:

• OME with prolonged effusion (6 months or longer);
• AND measured hearing loss;
• AND disability attributable to hearing loss (delay in speech development or other problems).

Combine adenoidectomy and grommet insertion if the child has nasal symptoms on top of otitis media with effusion


References:

1. Cochrane Database of Systematic Reviews 2005, Issue 1: Grommets for hearing loss associated with otitis media with effusion. Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I. Available online at: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001801/frames.html
2. BMJ Clinical Evidence: Otitis media with effusion (available online at: http://www.clinicalevidence.com/ceweb/conditions/ent/0502/0502.pdf, free registration required)

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