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.Explaining preoperative diagnosis to the parents:

Serous otitis media describes a collection of fluid in the middle ear. This may be acute (not lasting for a long time) or chronic (lasting for a long time).Now the condition of your patient is chronic.

Chronic serous otitis media may result from long-standing eustachian tube blockage or from thickening of the fluid so that it cannot be absorbed or drained down the tube. This chronic condition is usually associated with hearing impairment. There may be recurrent ear pain, especially when the individual catches a cold. Fortunately, serous otitis media may persist for many years without producing permanent damage to the middle ear mechanism. The presence of fluid in the middle ear, however, makes it vulnerable to recurrent acute infections. These recurrent infections may result in middle ear damage.

Along with this condition the tonsills and adenoids of the patient are also inflammed.

Adenoiditis is an inflammation of the adenoids. Adenoids are masses of lymph tissue that help the body fight infection. Adenoids are found in the pharynx (throat) just behind the nose. Along with the tonsils, adenoids are the first line of defense in your throat.

The lymphatic system performs several roles to help protect you from infection. Adenoids store white blood cells and antibodies that help to destroy possible infections threatening your health. Inflamed adenoids may not perform their function properly.

2.Description of operation procedure to the parents:

Surgical treatment of chronic serous otitis media may be recommended to reestablish ventilation of the middle ear, keep the hearing at a normal level, and prevent recurrent infection (which can damage the eardrum membrane and middle ear bones). Myringotomy (an incision in the eardrum membrane) is performed to remove middle ear fluid, which is drained with a ventilation tube. In rare cases, the drum membrane does not heal following dislodgment of the tube. The perforation may be repaired at a later date if this occurs. In adults, myringotomy and insertion of ventilation tube is usually performed in the office under local anesthesia. In children, general anesthesia is required. The adenoids are removed if enlarged.

More often than not, when the ventilation tube dislodges there is no further middle ear ventilation problem. Should serous otitis media recur, reinsertion of a tube may be necessary. In some difficult cases it is necessary to insert a more permanent type of tube. At times, a permanent hole in the eardrum develops when the tube is dislodged or removed. If this hole persists, it can be repaired at a later date when the eustachian tube blockage has subsided.

When a ventilation tube is in place the patient may carry on normal activities, with the exception that he must not allow water to enter the ear canal. Cotton with Vaseline or a custom-made ear mold will usually protect the ear from water.

The most common indication for ear tube insertion remains persistent (> 3 mo) serous otitis media (SOM), that does not resolve after 3 months of clinical observation or does not improve with antibiotic therapy.Ear tube insertion promotes drainage of middle ear fluid, which can cause speech and language delay if left untreated for a prolonged period. Middle ear fluid also predisposes to recurrent infections.

along with the tube insertion the tonsils and adenoids are also removed because of the infection in them

3. The colour of the fluid can suggest the cause of the otorrhoea. A purulent discharge indicates the presence of infection, while a bloody discharge may follow trauma or occur with granulation tissue associated with chronic infection. The presence of a mucoid discharge indicates a perforation of the tympanic membrane — there are no mucous glands in the external ear canal; the fluid must therefore arise from the middle ear. Clear, watery fluid, especially when associated with a history of trauma or skull base surgery, is likely to be CSF.

4.Otic drops

Uses

This medication is used to relieve pain, congestion, and swelling caused by middle ear inflammation (acute otitis media). This medication is also used to help remove earwax. This product contains 2 main medications. Benzocaine is a topical anesthetic that helps to numb the pain. Antipyrine is an analgesic that helps to decrease the pain and inflammation. This product may also contain glycerin, which helps to soften the earwax, and/or zinc acetate, which helps to protect the skin.

How to use A/B Otic

Use this medication exactly as directed by your doctor.

An antibiotic medication may sometimes be prescribed along with this medication if you also have an infection.

To make sure that the right amount of medication is given, and to avoid touching the ear with the dropper, have another person insert the drops if possible. To lower the risk of dizziness, hold the container in your hand for a few minutes to warm it. To apply ear drops, wash your hands first. To avoid contamination, do not touch the dropper tip or let it touch your ear or any other surface. Lie on your side or tilt the affected ear upward. Hold the dropper directly over the ear, and place the prescribed number of drops into the ear canal. To help the drops roll into the ear of an adult, hold the earlobe up and back. In children, hold the earlobe down and back. Keep the head tilted for about 2 minutes, or insert a soft cotton plug if so directed. You may be instructed by your doctor to moisten the cotton plug with this medication. Repeat for the other ear if so directed. Do not rinse the dropper. Replace the cap after use.

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