Discussion - bilateral conductive loss

Saket Aggarwal

Had a child, 9 years old, with bilateral conductive loss approximately 40 dB, impedance type B, myringotomy with grommets done. No improvement after surgery, Hearing loss same, Would need input from the forum

Harpreet Singh Kochar Intraop findings? Any glue? How many days since surgery.

Kapil Sikka may be ossicular discontinuity, or a wrong diagnosis!!!

Surinder K Singhal Why Type B in Ossicular discontinuity? It should be be Type D

Ninad S Narkar How much was the compliance? Can think of congenital ossicular fixation if compliance is low. Glue was probably coincidental.

Gowri Shankar may be the grommets are non functioning and blocked, taking that all the tests are done well

Saket Aggarwal almost 6 months now, had effusion. grommets are working well. checked under microscope. TM is normal now.

Saket Aggarwal any one else with similar experience!

Gowri Shankar kindly provide some more data reg : adenoids,mobility of TM, HRCT temporal bone findings on ossicular status etc.,

Chandrashekhar Tengli plz rule out chr.adenoiditis and take required steps incl Surgery!!!

Suri Prabhu yes - Saket Aggarwal - you must be this childs second or third doctor - and, the first doctor would have put in grommets (in the antero-superior segment) - and the resulting tympanosclerosis would have fixed either the malleus itself, or the mallear ligaments - the child needs to subjected to a siegle examination (which is not very difficult with a nine year old) - and you will find that (probably) the malleus does not move - confirm by direct palpation - and if that is the case, the next action is predicated -

Suri Prabhu and likely - that the hearing loss is not equal - more like 20 db in one, and 40 db in the other (with both thresholds not improving after grommets)

Saket Aggarwal Dear Suri Prabhu, unfortunately, I am the first surgeon, and I have no obvious explanation for the outcome. Hearing loss is equal in both ears

Gowri Shankar then tympanotomy can be tried

Harpreet Singh Kochar Long standing OME tends to cause adhesions in ME leading to entrapment of SSS. Would give you a B curve and as obvious the audiometry would show a CHL less than complete osscicular fixation. in this case a 40 dB loss sort o fits into picture. One other possibility is of nitrous pushing in the glue to posterior mesotympanum if the same was not switched off during surgery. The gelatinous glue tends to persist there. I would do a HRCT to evaluate further

Harpreet Singh Kochar During grommet insertion excess bagging by anesthetists needs to be checked. Tends to displace glue from ME and the whole purpose is defeated.

Ravi Sharma very interesting. How long did the child have a hearring loss for, before surgery. I suspect ossicular fixation / tympanosclerosis or ME adhesions. Suggest doing a Tympanotomy +/- CT scan.

Mohamed Mahaboob Shareef What did the child present with? Is it deafness/ speech problems. If it is persistent deafness , could it be intra op damage to ossicles ?