A 6-year-old child is brought with recurrent episodes of bilateral conductive hearing loss, mouth breathing, and snoring. Otoscopy shows bilateral dull grey tympanic membranes with no light reflex. Tympanometry reveals Type B curves bilaterally. What is the most appropriate first-line surgical management?
- A Adenotonsillectomy alone
- B Cortical mastoidectomy
- C Myringotomy with grommet insertion ✓
- D Myringoplasty with cartilage
Correct answer: C. Myringotomy with grommet insertion
Explanation
The clinical picture describes otitis media with effusion (glue ear): bilateral flat Type B tympanograms, dull featureless tympanic membrane, and conductive hearing loss. In a child with persistent bilateral glue ear and significant hearing loss (>25 dB HL for >3 months), myringotomy and grommet insertion is the first-line surgical treatment. Adenoidectomy may be added, especially in children over 4 years, but grommets address the immediate hearing impairment.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.