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CASE PRESENTATION

Dr. Rizwan Elahi ChohanMedical Officer

ENT Department

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Pt. name : Mohammad Ans KhanS/o : M. Jehangir Khan Designation:X-ray Tech.Directorate : DMSAge : 4 Yrs. Male R/o : Distt. MansehraD.o.A : 06-06-2003

Presenting Complaints:Delayed Speech-restricted to uttering of few words only,

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Birth History: SVD with no H/o birth trauma,

Family History: Nothing contributory,

Past History: Normal developmental mile stones,

with delayed speech,

GPE:

Pulse: 94/min. regular,

B.P: 100/70 mmHg

Temp. 98.6’ F

Anaemia, Cyansis, Jaundice, Clubbing-

All absent

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Systemic Examination:CVS: S1+S2+0CNS: No neurological deficit,Resp. System: Chest clearG.I. System: NAD

ENT Examination:Ears: Both T.M. appear pale yellow, lusterless, and bulged out, with distortion of cone of light,Nose: NADThroat: NAD

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Pre- op Work- up

Speech Therapy Assessment:

Findings:

• Delayed speech/ language with articulation deficit,• Language pattern- one word utterance• Limited vocabulary up to 50 words,

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Routine Investigations:

• CBC: HGB: 10.9 G/DlWBC: 7200/mm3Platelets: 487 thds/mm3ESR: 15mm/1st h

• Urinalysis:Sp. Gr. 1.020No glucose or albuminNo pus cells

• B.T. 3 min. 10 sec.• C.T. 4 min. 30 sec.

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Chest Radiogram

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Special investigations:

• Pure Tone Audiometry:

Child non- cooperative for the procedure,

• Free Field Audiometry:

Rt.(dB) Lt.(dB)

C-chime bar: 40 35

G-chime bar: 30 30

Manchester rattle: 35 40

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Tympanogram:Decreased compliance with negative pressure in both ears, suggesting bilateral effusion.

ConclusionBilateral, mild conductive hearing loss,

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DiagnosisOtitis Media with Effusion (Glue Ear) with delayed speech development.

Surgical InterventionBilateral myringotomy with V.T insertion was planned after assuring stable cardio- pulmonary status and fitness for G/A and necessary preoperative preparation. Surgery was done on 7, June, 2003 under general anesthesia with endotracheal intubation. Patient was positioned supine with head slightly tilted towards the opposite side and ear prepared for surgery.Surgery was done under operating microscope.

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Step1- Cleaning EAC of wax/ debris

MYRINGOTOMY

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Step2- Giving myringotomy incisionStep3- Suction/ clearance of effusion

MYRINGOTOMY

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Step4- Insertion of Grommet’s tube

MYRINGOTOMY

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Operative Findings

Thick glue like mucoid fluid was drained out from both the middle ear cavities.

This fluid is generally bacteriologically sterile. Ventilation tubes which were placed ‘in situ’ in both the tympanic membranes were left in position until they are rejected spontaneously, usually after six months.

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Post- op Follow up

Improved hearing with

better response of the child

to its environment,

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Post- op Audiogram

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After some regular, successful

speech therapy sessionsResults:• Improved recognition, discrimination and

identification abilities,• Improved expression- up to two to three word level,• Good imitation of words/ phrases, • Improved articulation,• Vocabulary improved to 50- 100 words.

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Conclusion

Surgery + Speech Therapy

The child has improved hearing,

with speech and language development,

better articulation, expression and vocabulary.

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