Tympanometry is a noninvasive test used for measuring middle ear pressure. Increased pressure can also cause a bulging TM. Local symptoms and signs include hearing loss, feeling of fullness in the ear, a 'popping' sensation and a dull retracted tympanic membrane (TM) with restricted mobility on saegalisation often with air bubbles behind the TM. Enlarged adenoid causes tubal obstruction at its nasopharyngeal opening and causes reduction of middle ear pressure and compliance towards negative side due to absorption of gas which leads to otitis media with effusion. The normal middle ear pressure is -100 mm of H 2O to + 50 mm of H 2O and the normal middle ear compliance is 0.39 ml to 1.30 ml. The classical concept is that enlarged adenoid or recurrent infection of adenoids causes recurrent acute otitis media and OME. Enlarged adenoids block the eustachian tube causing conductive hearing loss. Symptoms due to adenoid and tonsillar hypertrophy include nasal obstruction, snoring, mouth breathing and hyponasal speech. The main reasons postulated for adenotonsillectomy as a means of treatment and prevention of recurrence have centred on the size of the adenoids and the role of recurrent tonsillitis as a focus for ascending eustachian tube infection. Allergy of the upper respiratory tract may also contribute to enlarged adenoids. Recurrent attacks of rhinitis, sinusitis and chronic tonsillitis may cause chronic adenoid infection and hyperplasia. Adenoid hypertrophy is an important etiological factor in the causation of OME. It is the leading cause of hearing loss and a social morbidity in children which has long-term consequences for speech and language development. Otitis media with effusion (OME) is an important and common condition in paediatric age group.
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