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.Chronic serous otitis media usually starts in childhood which is caused due to adenoidal tissue overgrowth that blocks eustachian tube causing rhinitis, edema. The improper treatment of acute otitis media accumulates resistant bacteria resulting in chronic otitis media .It is a longlasting infection of middle ear due to thickening of fluid in the middle ear or blockage of eustachian tube. Here mainly sterile serous fluid from blood vessel enters the membrane of the middle ear.The short naroow horizontal structure of eustachian tube blocks the fluid in the middle ear. It results in hearing impairment with severe pain and recurrent cold. It is also due to blockage of adenoids

2.Bilateral myringotomies is the incision ear drum membrane of both the ears that removes fluid accumulated in the middle ear that is drained through ventilation tube inserted in the eardrum. The adenoids gets enlarged due to chronic otitis media and thus they are removed. The incision of tonsils also done in the surgery.

3. The purulent discharge indicates the presence of infection in the ear associated with blood discharge due to thickening of fluid and granulation of tissue due rupture of tymphanic memrane in chronic infection.

4. Otic drops are sloutions containing antibiotic gentamycin or Ofloxacin, quinolone compound used as antipyretic in treating chronic infection that kills bacteria.

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