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Q. How can adhesive otitis with SOM be treated?

Answered by
Dr. Shyam Kalyan. N
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Apr 25, 2019

Hello doctor,

I am 33 years old, male. I am diagnosed with right adhesive otitis with left SOM. Already mastoidectomy was done in right ear nine years back and two myringotomies in right ear when I was 4 and 7 years of age. I have CT scan report, audiometry, impedance test results.

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Hi,

Welcome to iclinq.com.

Can you upload audiometry report? What are the complaints now? Is there discharge or hearing deficit? Any pain or giddiness? Nose CT seems fine (attachment removed to protect patient identity). Ear shows mastoiditis. Have they done an ear under microscope examination? If it is a clearly diagnosed adhesive otitis media supported by audiometry it will need surgery. But which ear to be done first will depend on audiometry. Is there any nasal complaints?

Thank you doctor,

I went to the doctor because I was having echo in right ear. The doctor saw inside of ear through video endoscope and said that the right ear drum is collapsed. It is retracted fully, which is posible in monitor. Left is recovering well. He suggested myringotomy after seeing audiometry. Once CT was taken, the doctor said myringotomy in right will not help as there is chronic ottitis. So revision mastoidectomy was suggested in right and myringotomy in left. Audiometry results have been attached. No nasal problems now. No discharge, hearing deficit slightly.

#

Hi,

Welcome back to icliniq.com.

Your diagnosis and description given by your ENT doctor matches with the pure tone audiogram and tympanometry findings (attachment removed to protect patient identity). Your condition will not improve without surgery. If the condition had occured recently we could have tried with medicines. Since yours has been occuring since childhood we need surgery.

Revision mastoidectomy surgery with hearing reconstruction is required in right ear. We will have to drill the mastoid bone and check what is causing the atelectasis and retraction. If there is any soft tissue mass inside like cholesteatoma. In the left a simple myringotomy grommet insertion is enough for now. We can do both procedures in a single sitting. You would need a complete anesthesia fitness to undergo the surgery under general anesthesia.

The tympanometry curves also suggest the same. Right ear has more hearing deficit than left. If you leave the two without addressing or trying conservative treatment then the hearing may worsen and the disease may enter deeper into ear and risk the brain as well. After surgery, you will need to monitor nose, nasal symptoms. Any allergy should be immediately addressed. You would need a nasal endoscopy to check if there is any eustachian tubal blockage that is causing the repeated ear problems.

You must avoid smoking and any exposure to dust pollution, etc.

Hi doctor,

Thank you for a detailed answer. It cleared many doubts and confusions. Some doubts again are:

Do you think the reason for recurrence is allergy related. If so, any anti-allergy treatment is required prior to surgery? I was not having visible running nose for a long time now (minor cold was there 2 to 3 times in last four months). The doctor said that for him it looks like 7 to 8 months old. My sinus is clear from CT reports. Still is there a chance to conclude whether it is allergy related?

The doctor was saying that, in my case infection was observed from inner to eustachian tube unlike in normal cases where eustachian tube gets blocked due to cold, from outside to inside. If that is the case, whether these infections will come back after this surgery also? How commonly is a revision mastoidectomy performed?

From the reply, I understand that you do not suggest a conservative approach of waiting and doing surgery as a last option. Do you think proper care and medicines can subside the present situation? If we are postponing surgery, are there chances for the infection to spread?

#

Hello,

Welcome back to icliniq.com.

I am not saying that reason for recurrence is allergy or allergy related. In many patients we see that some nasal pathology can cause eustachian tube block and consequent ear problems. This may be true in your case. The nasal issue can be polyps or deviation of allergy or adenoids. Allergy is one of the possibilities.

Revision mastoidectomy is not uncommon. Many patients require that. As a percent text books and researches it is mentioned that about 10 % cases require second surgery.

Allergy is a condition and cannot be cured. We may investigate and find out what you are allergic to and give necessary precautions and measures. Immunotherapy can also be attempted if we find out some specific allergen. For the right ear I do not think a conservative approach will work. For the left we may try. But when you are doing a surgery in right you might do the smaller procedure in left as well. Medicines may subside the fluid or retraction in left over long term but will not cure the right. But even in left there might be recurrence.


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