Review the report and answer the questions that follow: Preoperative Diagnosis:

Question

Review the report and answer the questions that follow:

Preoperative Diagnosis: Bilateral chronic serous otitis media; tonsillo-adenoiditis

Operation: Bilateral myringotomies and ventilation tube insertion; Tonsillectomy and adenoidectomy

Procedure: With the patient in the supine position and under general endotracheal anesthesia, inspection was made under the operating microscope. The external canal was clear, tympanic membrane was divided. A purulent discharge appeared to be present. This drainage was suctioned out and the ear thoroughly lavaged. A ventilating tube was put in place and otic drops were administered. Same procedure for other ear canal.

The patient was placed in the Rose position (supine with the head over the table edge in full extension) and the adenoids removed with adenoid curettes and adenoid biopsy forceps. A nasopharyngeal sponge was put in place. The right tonsil was then grasped with tonsil forceps, dissected free, and removed with snare. Bleeding was controlled with suction cautery, The nasopharyngeal sponge was removed and no further bleeding noted. The patient tolerated the procedure well and left the OR in good condition.

1.  How would you describe the patient’s preoperative diagnosis to the parents?
2. How would you describe the operative procedure to the parents?
3. What would account for the presence of purulent discharge?
4. What are otic drops and why would the be used?

Explanation / Answer

1. Tonsillo-adenoiditis is a chronic inflammatory condition of the fleshy tissues that lie on back of the mouth (tonsils) and inflammation of lymphoid tissue present at the roof of the mouth (adenoids). Generally these tissues are involved in providing immune response. If the inflammation does not go away, chronic inflammation of these tissues occur. As there is no potential cure for this, surgical removal is the best option for the treatment of tonsillo-adenoiditis.

Otitis media is an inflammation of the middle ear, caused by bacteria or virus. Bilateral myringotomies and ventilation tube insertion is done to clean the ear. After this, otis drops will be prescribe, which relieve the pain.

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