Aim: To determine the association between adenoidal nasopharyngeal ratio (AN ratio) and tympanogarm in children before and after medical therapy.

Materials and Methods:  A prospective clinical study conducted from June 2014 to May 2015. comprising of75 children between 4-12 years of age who were clinically diagnosed to have adenoids and Otitis media with effusion and were undergoing medical management in the Department of ENT, Academy of Medical Sciences, Pariyaram, Kerala, India. The adenoidal nasopharyngeal ratio (AN ratio) was calculated with digital X- ray of nasopharynx and correlated with tympanometric values before and after medical treatment of otitis media with effusion. The relationship between AN ratio and tympanograms were evaluated regarding AN ratio 0.70.The Chi square test was used to analyze the correlation between AN ratio and tympanometric values..The children who did not show response to medical treatment after a period of 12 weeks were subjected to surgery in the form of adenoidectomy, with or without grommet insertion.

Results: Digital x-ray nasopharynx lateral view of 75 children showed a mean over all Adenoidal nasopharyngeal ratio (AN ratio) of 0.729 Vs 0.615 before and after medical therapy. B and C type tympanograms were seen in children with Eustachian tube dysfunction resulting from enlarged adenoids with AN ratio more than 0.70.After initiating medical therapy, children with AN ratio greater than 0.70  with B and C type tympanograms did not show statistically significant  improvement in middle ear pressures (P < 0.001) compared to those children with ANRatio less than 0.70 and C type tympanograms. Thus although medical treatment was effective in shrinking the size of adenoid tissue, it did not result in statistically significant change in tympanometric values (P< 0.001).Children who were non responders to medical management with persisting fluid in the middle ear (with Type B tympanogram) were considered  for adenoidectomy and grommet insertion.

Conclusion: Otitis media with effusion (OME) is the most frequent causes of silent hearing impairment in young children with adenoid hyperplasia which needs a close vigil. Correlating adenoid nasopharyngeal ratio and tympanometric findings we found that even though medical management causes reduction in size of adenoids, it is not sufficient in a child with OME. Hence younger children with AN ratio more than 0.70 and B type tympanogram are the definitive candidates for surgical management. Hopefully this study will facilitate to detect early those children with OME who will not be benefited by medical management alone.

Keywords: Adenoidal nasopharyngeal ratio; Tympanogram,  X ray Nasopharynx lateral view; Eustachian tube dysfunction; Adenoidectomy.

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Dr Deepa. Reghunathan

Associate Professor, Department of Otolaryngology- Head and Neck Surgery,

Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India

Ph.no – 91-9895237523, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.