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INTRODUCTION

           

This study will include the pattern of hearing impairment in children with otitis media with effusion (OME) in Pakistan. Glue ear is an ailment where the middle ear gets occupied with a sticky glue like fluid in its place of air. Glue ear or otitis media with effusion (OME) is common in children based in the developing countries and may be associated with hearing loss (HL). Mostly, in children it has no extensive direct effects on cognitive development.1

            OME is standout amongst the most ordinarily occurring infantile illness in the Pakistan alongside other developing and mechanical nations like India and China with more than 2 million analyzed cases every year at an expected yearly cost of 4 billion Pakistani rupees. 90 percent of children (80% of individual ears) will have no less than one event of serous otitis media by age 6, with the greater part of cases coming to pass for between the ages of a half year and 4 years.2

            Numerous cases of OME resolve unexpectedly inside three (3) months of time after intervention, yet 40 percent of children have repeated episodes and 5 to 10 percent of cases last more than one year.3

            Few subpopulations of children are lopsidedly influenced by glue ear, particularly incorporating those with a Down disorder, Cleft Palate and other craniofacial inconsistencies 4 are at high risk for anatomic reasons for OME notwithstanding impaired capacity of the Eustachian tube. There are a few predisposing ecological variables that are related with an expanded danger of creating OME. These incorporate presentation and exposure to smoke, attending child care, and earth prompted hypersensitivities.

            OME can be related with inconvenience and a sentiment totality in the ear. Patients with OME are likewise inclined to scenes of intense otitis media (AOM). Acute hearing impairment is normal among OME patients. This hearing loss is frequently mellow (i.e., compounded or with hearing limit raised by around 10 dB), yet now and again direct to extreme hearing loss can include the nerve. Hearing loss in children may postpone or for all time change their relational abilities and may prompt behavioral and instructive challenges. Taking a watchful history is vital to recognize the risk factors of OME. For instance, it can be useful to inspire a past filled with late upper respiratory contamination, sensitivity, subjective hearing loss or unevenness, dialect delay, and a background marked by congenital fissure or Down syndrome.5

            Indicatively, OME must be first recognized and afterward distinguished from Acute Otitis Media. OME is diagnosed with the presence of fluid behind the tympanic membrane, without acute onset or signs of inflammation or infection. AOM on the other hand, while it may include Eustachian tube dysfunction and middle ear fluid, it must include signs of acute inflammation or infection.6

 

                                      LITERATURE REVIEW

 

            This study established that the as defined in the fresher models of study of otitis media with effusion the key event is inflammation of the middle ear mucosa caused by a reaction to bacteria commonly, Streptococcus pneumoniae, already present in the middle ear cavity.             Otitis media with effusion is omnipresent in children who have a cleft palate. The motive is in reality the lack of proper insertion of the Tensor Veli Palatini muscle inside the smooth palate. The muscle is, therefore, unable to open the Eustachian tube on swallowing or wide mouth beginning. Age is another predisposing element in the improvement of otitis media with effusion.7 

            In infants, the Eustachian tube has a nearly horizontal aligned (relative to the floor) and develops the 45° (as in adults) after numerous years. Further, the dimensions and shape of the Eustachian tube at beginning, in contrast to the ones in adults, are hostile for airflow of the middle ear.            Multiple researches revealed that by the time children have been aged 12 months, tympanograms were both type B (flat) or type C (negative) in 24% of cases. Development happened in the spring and summer, whereas worsening changed into greater common within the winters and the monsoons in Pakistan. Typical Type B tympanograms peaked in children aged two-four (2-4Y) years, and, as anticipated with the prevalence of otitis media with effusion, reduced in kids older than 06 years.
            Clinical course of action from a joint commission of specialties document that screening surveys of healthy children between infancy and age 5 years show a 15-40% point prevalence in middle ear effusion (MEE). Furthermore, among children examined at regular intervals for 1 year, 50-60% of child care attendees and 25% of school-aged children were found to have a middle ear effusion at some point during the examination period, with peak incidence during the winter months.8 Surgical intervention with strain equalization tubes (PETs) and adenoidectomy is normally finished in ambulatory surgical-treatment settings.            A number of clinical interventions were cautioned for the treatment of otitis media with effusion, all with arguable however basic terrible consequences. historically, if a middle ear effusion (MEE) persists for 03 months, surgical intervention changed into indicated.9            Document the laterality, length of effusion, and presence and severity of associated symptoms at each assessment of the child with otitis media with effusion.Children with persistent otitis media with effusion who are not at risk ought to be reexamined at three-6 months durations until the effusion is now not present, enormous listening to loss is identified, or structural abnormalities of the eardrum are suspected.
                An Otolaryngologist should be consulted every time the Primary Care Physician (PCP) is concerned about chronic conductive hearing loss in children, in particular those with symptoms of language delays.It’s far endorsed averting using antibiotics, decongestants, oral steroids, and antihistamines for the remedy of otitis media with effusion because of proof that cites their loss of effectiveness

                                      4b. AIMS & OBJECTIVES

                                                                        (Rationale)

1.    To assess the pattern of hearing loss in children with serous otitis media in public hospitals of Lahore, Punjab.

2.    To evaluate the basic causes of hearing loss in children with glue ear.

3.    To evaluate the type and degree of hearing loss in children with otitis media with effusion.

                                  5a. Hypothesis

1.    Research Hypothesis: The pattern of hearing loss in usually moderate degree conductive hearing loss.

2.    Null Hypothesis: The pattern of hearing loss ends up being the sensorineural hearing loss or mixed involving the nerve and the air conduction pathway.

                               5b. MATERIALS AND METHODS

         5.1. Inclusion criteria:

·      Only children will be included in this study.

·      Male and female both included.

·      The study will include the clinical outcomes such as changes in middle ear fluid.

         5.2. Exclusion criteria:

·      Adults will not be included.

·      Children with less than 3 months of age.

         5.3 Dependent variable:

·      Frequency

·      Intensity

·      Hearing Thresholds

 

         5.4. Independent variables:

·      Gender

·      Age

·      Laterality (Left and Right ear)

        5.5. Place of study

     

·Children Hospital, Lahore (ENT Out Patient Department)

·Mayo Hospital, Lahore. (ENT Out Patient Department)

·Services Hospital, Lahore (ENT Out Patient Department)   

             5.6. Duration of study

·      Six months after the approval of synopsis.

 

6. Population and sampling method/sample size

                      6.1. Population: Patients coming at Mayo Hospital, Services                                   Hospital,Children Hosital; OPD.

                      6.2. Sampling method: Non probability purpose and convenient                         study.

                      6.3. Sample size: 50 patients (Children) with Effusion or Glue ear.

                      6.4.Sample design: Cohart study.

                       6.5.Data collection method: Examination of 50 patients, This study                             will be initiated after approval from advanced study & research committee                          (ASRC) of ISRA institute of Rehabilitation Sciences.

                                6.6.Tools: Pro Forma containing

·         Patient profile

·         Clinical examination

·         Self-made Pro forma.

 

                                6.7. Instruments /equipment to be used:

·         Otoscope

·         Audiometre

·         Tympanometre

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