Unmask the silent hearing loss: a study of audiological profile in children with chronic adenotonsillitis

Hosaagrahara Subbegowda Satish, Somashekhar Abhilasha


Background: Chronic adenotonsillitis results in obstruction of eustachian tube (ET) due to edema, by mechanical obstruction and the upper respiratory tract infection disrupts the mucocilliary action of ET which can lead to otitis media with effusion (OME). This when unresolved can result in persistent hearing loss and this might cause subsequent delay in development of language, social behaviour, learning difficulties which will affect the academic performance. Young children as are unable to voice their hearing loss and sometimes due to inattentiveness of parents to child’s hearing disorder; this might be neglected. The condition remains masked for a long time and hence need to be unmasked for its appropriate management.

Methods: It is cross sectional study involving cases of chronic adenotonsillitis from November 2016 to May 2018. After enrolling the patients who met the inclusion criteria, their demographic details, examination findings including the findings of x-ray nasopharynx, pure tone audiometry (PTA) and tympanometry were noted for analysis.  

Results: Total 100 patients were studied in which history of hearing loss was seen in 23% and parents’ suspicions was in 22% of cases whereas hearing loss was demonstrated in 51% of cases using PTA ranging from 16-70 db in hearing level. Analyses of tympanogram revealed 43% to have either type B or type C tympanogram which are suggestive of OME.

Conclusions: Audiological screening for children diagnosed with chronic adenotonsillitis needs to be made mandatory to detect OME, the silent hearing loss as parents as well as children will miss out on it.


Chronic adenotonsillitis, OME, Pure tone audiometry, Tympanometry

Full Text:



Robb PJ. The adenoid and adenoidectomy. In: Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al, eds. Scott-Brown's Otorhinolaryngology: Head and Neck Surgery. 7th ed. London: Hodder Arnold; 2008: 1094-1101.

McKerrow WS. Diseases of the tonsil. In: Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al, eds. Scott-Brown's Otorhinolaryngology: Head and Neck Surgery. 7th ed. London: Hodder Arnold; 2008: 1219-1228.

Ren DD, Wang WQ. Assessment of middle ear effusion and audiological characteristics in young children with adenoid hypertrophy. Chinese Med J. 2012;125(7):1276-81.

Nwosu C, UjuIbekwe M, ObukowhoOnotai L. Tympanometric Findings among children with adenoid hypertrophy in Port Harcourt, Nigeria. Int J Otorhi. 2016:1276543.

Vijayan A, Ramakrishnan VR, Manjuran TJ. Relationship between adenotonsillar hypertrophy and otitis media with effusion. Int J Cont Med Res. 2018;5(2):B1-5.

Browning G. Otitis media with effusion. In: Gleeson M, Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, et al, eds. Scott-Brown's Otorhinolaryngology: Head and Neck Surgery. 7th ed. London: Hodder Arnold; 2008: 877-911.

Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, et al. Clinical Practice Guideline Otitis Media with Effusion Executive Summary (Update). Otolaryngol Head Neck Surg. 2016;154(2):201-14.

Sallavaci S. Prevalence and factors associated with hearing impairment in preschool children in Albania. Arch Med. 2016;8:4.

Sanli A, Tasdemir O, Eken M, Celebi O, Yilmaz SH. Prevalence of otitis media with effusion among primary school age-children and etiopathogenic examination. Ind J Otolaryngol Head Neck Surg. 2014;66(1):95-8.

Sharma K, Pannu MS, Arora A, Sharma V. Preventive audiology: screening for hearing impairment in children having recurrent URTI. Ind J Otolaryngol Head Neck Surg. 2016;68(2):163-6.

Ajayan PV, Raj DML, Jacob AM. A study on the effect of adenoidectomy with tonsillectomy in otitis media with effusion in children. Int J Res Med Sci. 2017;5:1796-801.

Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. Am J Roentgenol. 1979;133(3):401-4.

Sharma K, Mehan R, Arora A. Clinicoaudioradiologicaland operative evaluation of otitis media with effusion. Indian J Otol. 2015;21:1748.

Khmmas AH, Dawood MR, Kareem A, Hammadi YA. Diagnostic accuracy of otitis media with effusion in children. Mustansiriya Med J. 2016;15(1):1-6.

Al-Juboori AN, Al-Aqeedee AA, Saeed HD. Otitis. Media with Effusion in Children: A Follow up Study in West Baghdad, Iraq. J Commun Dis Deaf Studies Hearing Aids 2014;2(4):2375-4427.

Orji FT, Mgbor NC. Otoscopy compaired with tympanometry: an evaluation of the accuracy of simple otoscopy. Niger J Med. 2007;16(1):57-60.

Syed HI, Arif HB, Abu Yusuf F. Study on otitis media with effusion. Bangladesh J Otolrhinolaryngol. 2009;15:50-4.

Schönweiler R, Ptok M, Radü HJ. A cross-sectional studyof speech- and language-abilities of children with normalhearing, mild fluctuating conductive hearing loss, or moderateto profound sensoneurinal hearing loss. Int J Pediatr Otorhinolaryngol. 1998;44:251-8.

Skarznski H, Piotrowska A. Screening for pre-school andschool-age hearing problems: European Consensus Statement. Int J Pediatr Otorhinolaryngol. 2012;76:120-1.

Kocyigit M, Ortekin SG, Cakabay T, Ozkaya G, Bezgin SU, Adali MK. Frequency of serous otitis media in children without otolaryngological symptoms. Int Arch Otorhinolaryngol. 2016.

Günel C, Ermişler B, Başak HS. The effect of adenoid hypertrophy on tympanometric findings in children without hearing loss. Kulak Burun BogazIhtis Derg. 2013;24(6):334-8.

Babu S, Prabakaran J, Radhakrishnan S. Prevalence and management of otitis media with effusion amongst the school going children of a rural area in Puducherry. Bengal J Otolaryngol Head Neck Surg. 2016;24(1):21-8.