Adenoidectomy Before Or After Myringotomy In A Single Stage Procedure: Does The Sequence Matter?

Objective: To evaluate the sequence of performing adenoidectomy or myringotomy first in a single stage procedure has any bearing on the per- operative outcome on middle ear effusion and subsequent grommet insertion in a patient of otitis media with effusion (OME). The hypothesis was that initially performed adenoidectomy allowed the middle ear fluid to drain passively and precluded grommet insertion. Study Design and Setting: Comparative study conducted at Department of ENT, Combined Military Hospital Sialkot and PNS Shifa Hospital Karachi, from Jun 2016 to Jun 2017. Methodology: One hundred and twenty patients (218 ears) with OME and adenoid hypertrophy, meeting the inclusion criteria, were inducted in this study and divided into 2 groups. Group A (60 patients with 110 ears) had adenoidectomy first followed by myringotomy and or grommet insertion, while Group B (60 patients with 108 ears) had myringotomy with or without grommet insertion first and followed by adenoidectomy. Result: There were 76 males and 44 female patients with a ratio of 1.7:1 and the age range was 3 to 14 years with a mean age of 4.81 ± 0.77 years. There was a significant difference between the two groups. Out of a total of 110 ears in group A, 74 ears (67.2%) had no mucoid fluid or dry tap on myringotomy in contrast with group B where out of total 108 ears, only 26 ears (24.1%) had dry tap or no mucoid fluid (p = 0.001). Conclusion: Adenoidectomy performed before myringotomy significantly reduced the need for grommet insertion. Larger studies however are needed to corroborate these findings.