Changes in Middle Ear Function after Adenoidectomy in Children with Adenoid Hypertrophy

Abstract

Background: Adenoid hypertrophy in children often causes Eustachian tube obstruction and otitis media with effusion (OME), leading to conductive hearing loss. Adenoidectomy is routinely performed to relieve nasal obstruction and improve middle ear ventilation, but evidence on its effect on ear function is mixed. This study evaluated changes in tympanometry and hearing thresholds before and after adenoidectomy in children with significant adenoid hypertrophy.

Materials and Methods: We conducted a prospective observational study of 51 children (mean age ≈9.0 years; 49% male) with grade III–IV adenoid hypertrophy undergoing adenoidectomy. Preoperative and postoperative (at 1, 3, and 6 weeks) assessments included otoscopy, impedance audiometry (tympanometry), and pure-tone audiometry. Tympanograms were classified as Type A (normal), B (effusion), or C (negative middle ear pressure). Hearing thresholds (air-conduction pure-tone average at 500–4000 Hz) were recorded for each ear. Data were analyzed with paired statistical tests; significance was set at p<0.05.

Results: All patients had nasal obstruction, and 70% had snoring or breathing difficulty. Preoperatively, 76% of ears had flat (type B) or negative-pressure (type C) tympanograms (middle ear effusion), and only 23% were normal (type A). After adenoidectomy, normal tympanograms increased progressively: 24% at 1 week, 44% at 3 weeks, and 81% at 6 weeks (Table 2). The increase in Type A curves by 6 weeks was significant (p<0.001). Mean hearing thresholds improved markedly: right ear PTA improved from 27.3±9.7 dB preop to 18.6±5.9 dB at 6 weeks, and left ear from 28.8±10.2 dB to 17.7±4.7 dB (both p<0.001). Figure 1–3 illustrate normal middle ear findings and the audiometric improvement.

Conclusion: Adenoidectomy leads to rapid and significant recovery of middle ear function in children with adenoid hypertrophy. By 6 weeks postoperatively, most children demonstrated normalized middle ear pressure (type A tympanogram) and hearing thresholds near normal. These findings support early surgical intervention to prevent chronic OME and hearing loss in this population.