Question

Review the report and answer the questions that follow:

Preoperative Diagnosis: Bilateral chronic serous otitis media; tonsillo-adenoiditis

Operation: Bilateral myringotomies and ventilation tube insertion; Tonsillectomy and adenoidectomy

Procedure: With the patient in the supine position and under general endotracheal anesthesia, inspection was made under the operating microscope. The external canal was clear, tympanic membrane was divided. A purulent discharge appeared to be present. This drainage was suctioned out and the ear thoroughly lavaged. A ventilating tube was put in place and otic drops were administered. Same procedure for other ear canal.

The patient was placed in the Rose position (supine with the head over the table edge in full extension) and the adenoids removed with adenoid curettes and adenoid biopsy forceps. A nasopharyngeal sponge was put in place. The right tonsil was then grasped with tonsil forceps, dissected free, and removed with snare. Bleeding was controlled with suction cautery, The nasopharyngeal sponge was removed and no further bleeding noted. The patient tolerated the procedure well and left the OR in good condition.

1. In lay terms, give a complete description of the patient’s preoperative diagnoses for the parents.
2. Again in lay terms, please describe the complete operative procedure to the parents. Cite your sources.
3. What would account for the presence of purulent discharge?
4. What does the term otic drops mean, and why might they be used in this case?

Answer 1

1.Otitis media refers to the swelling of the middle ear.It is due to the result of Infection. This is accompanied with severe pain .This could be because if infection,adenoid which are infected and swollen up ,even when a children have cold or allergic condition.Tonsillo-adenoitis is the swelling of tonsils and adenoid due to infection. Usually otitis media is inter related with tonsillo-adenoitis

2.The treatment for this is operation.It is two different operation for two different condition causing the same symptoms. Patient will be laid flat ,a tube will be passed via the throat and given anaesthesia or medicine for numbness.Now with the help of microscope the pus filled discharge in the ear is cleaned by pulling it out with suction and then a ventilating tube is passed and finally otic drops are instilled and the same procedure will be repeated in other ear

Now the patient will be place on back with head elevated and tilted backwards.The adenoids are removed,then the right tonsils are removed and the bleeding is stopped and patient is shifted from operation room

3.The purulent discharge is a clear indication of infection and bit is generally caused by bacteria

4.The word otic in simple term refers to be ear.The drops instilled in the ear are called otic drops.In this case it is used to treat an infection ,control pain post operatively.