A 4-year-old male presented with delayed speech development, restricted to uttering few words. Examination found pale, bulging tympanic membranes. Audiometry revealed bilateral mild conductive hearing loss. The diagnosis was otitis media with effusion. Bilateral myringotomy with ventilation tube insertion was performed. Post-operatively, the child's hearing improved and speech therapy led to gains in recognition, expression, articulation, and vocabulary. The conclusion was that surgery and speech therapy helped the child's hearing, speech, and language development.

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CASE PRESENTATION
Dr. Rizwan Elahi Chohan
Medical Of f icer
ENT Depart ment

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Pt. name : Mohammad Ans Khan
S/o : M. Jehangir Khan
Designation:X-ray Tech.
Directorate : DMS
Age : 4 Yrs. Male
R/o : Distt. Mansehra
D.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+0
CNS: No neurological deficit,
Resp. System: Chest clear
G.I. System: NAD
ENT Examination:
Ears: Both T.M. appear pale yellow, lusterless,
and bulged out, with distortion of cone of light,
Nose: NAD
Throat: 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/Dl
WBC: 7200/mm3
Platelets: 487 thds/mm3
ESR: 15mm/1st h
• Urinalysis:
Sp. Gr. 1.020
No glucose or albumin
No 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.
Conclusion
Bilateral, mild
conductive hearing loss,

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Diagnosis
Otitis Media with Effusion (Glue Ear)
with delayed speech development.
Surgical Intervention
Bilateral 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
incision
Step3- Suction/ clearance of
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 sessions
Results:
• 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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