Zheltov A. Diagnosis and treatment of the diseases of nasopharyngeal lymphoid tissue in children with otitis media with effusion

The aim of the work is to increase the efficiency of diagnostics and treatment of pharyngeal lymphoid tissue hypertrophy in 5-7 year children with otitis mediawith effusion(OME)by usingendoscopic technique and modern methods of removing pathological lymphoid growths (shaver, cobulation). There were 117 children with pharyngeal tonsil hypertrophy (PTH) and OMEat the age of 5 to 7 years who had not previously undergone adenotomy. Two groups of observation were formed: group 1 –children with chronic purulent adenoiditis and OME, who surgically removed adenoids to the maximum possible extent (n=27); group 2 –children with PTHand OME,who underwent surgical removal of adenoids in a sparing volume (n=90). It was proved that PTHin children with OMEis the of vegetative innervation local imbalance source of the mucosa with a predominance of the parasympathetic component that does not depend on the degree of increase in the tonsils, resultingin vasodilation with increased vascular permeability, edema and glands secretory activity, and their maintenance in the future. An innovative approach to the PTHsurgical treatment method choice in children with OMEis proposed: selective removal of part of the PT, which irritates the active zone of vegetative innervation of the nasopharynx in the area of the Roshenmuller fossa and lateral wall, which leads to a decrease to 3.3% of OMErelapses, in contrast to 14.8% with a radical removal of PTand 18.0% with a standard adenotomy. Long-term results within 2 years after visually controlled adenotomy in children with PTHand OMEdemonstrated a decrease in the number of OMErelapses compared with usual adenotomy (3.3% and 18.0%, respectively) with 93% ofchildren cured, hearing restoration in 95,8% of children and minimal (no more than 6%) cicatricial changes in the nasopharynx.