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322

THE EAR

most acceptable method of achieving this in children is to encourage them
to chew gum.

Removal of the adenoids, and of tonsils if there are sufficient reasons for
this, may be performed under the same anaesthetic as for the myringotomy.
Some surgeons recommend this routinely while others only remove the
adenoids if they are large, or if there is a history of earache.

PROGNOSIS. The immediate result of myringotomy and aspiration of the
fluid is an improvement in hearing, often to normal on audiometry (fig.
168). In some 70 per cent of cases this is permanent. Recurrences of fluid

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180 STANDARD

Fig, 168. Audiogram showing a return, to normal hearing following myringotomy and aspiration

of a *glue* ear.

and deafness are found in about 20 per cent, and these are treated in the
same manner. It is usual to insert a grommet on this occasion. A small
percentage have further recurrences, and in them mastoid radiography may
show cellular breakdown. On opening the mastoid considerable destruction
of the cells is found with glue throughout, especially in the tip cells.

Long-term follow-up shows that tympanosclerosis is the most common
complication, and there is evidence to suggest that the insertion of grommets
may have a bearing on this. Much more serious is the development of atrophic
areas in the tympanic membrane, particularly in the attic or the postero-
superior regions. This leads to the formation of retraction pockets, and these
form a potential source of cholesteatoma formation with its sequelae.

TYMPANOSCLEROSIS

In the past this has been known under various titles—chronic adhesive
otitis media, chronic adhesive catarrh, chronic catarrhal otitis media, etc.
In more than half of the cases in which this diagnosis has been made there
has been a previous history, and often clinical evidence, of middle ear
suppuration. In other cases the adhesive process has resulted from non-
suppurative otitis media, possibly undiagnosed or inadequately treated. The
latter aetiological factor has undoubtedly assumed greater importance as a
result of premature cessation and inadequate dosage of antibiotics. The