Secretory otitis media

Synonym : Otitis media with effusion

                : Serous otitis media

                : Non suppurative otitis media

                : Glue ear

Definition : Is defined as clinical conditions characterized by the presence of non-purulent fluid in the middle ear cleft.

Incidence :

20-50% children have an episode of otitis media with effusion at sometimes between the age of 3 to 10 years.

Predisposing factors :

1. Occlusion of the Eustachian tube :

May result from- Adenoids

                         - Tubal infection

                         - Stricture after adenoidectomy

                         - Neoplasm of postnasal space

                         - Paralysis of palatal muscle

                         - Nasopharyngeal atresia

                         - Postnasal packs

2. Unresolved acute otitis media

3. Viral infections of the middle ear cleft lining- e.g. rhinitis, pharyngitis, nasopharyngitis, sinusitis

4. Allergy

5. Cleft palate and its repair

Pathology :

Blockage of Eustachian tube-

Absorption of middle ear air and impaired middle ear drainage-

 Negative middle ear pressure-

serous or thick mucous fluid collection in middle ear-

nonsuppurative inflammation

Symptoms- Unilateral or Bilateral

 - Blockage of the ear or heaviness of the ear

-         Autophony

-         Hearing impairment : hearing is usually better in bed when supine but it clouds over when getting up (erect position)

-         Tinnitus

Signs :

-         Dull and retracted tympanic membrane

-         Absent or distorted cone of light

-         Prominent short process of malleus

-         Foreshortened and horizontal handle of malleus

-         There may be air bubbles and fluid level behind the tympanic membrane

Investigations :

-         Pure tone audiometry : Conductive deafness

-         Impedance audiometry : low compliance and negative middle ear pressure

-                    - Type B (Flat curve)

-         3. To find out the source of infection

-                e.g. X ray nasopharynx lateral view

-                       X ray PNS O-M view etcTuning fork test : Conductive hearing loss

-         Pneumatic otoscopic exam : shows impaired tympanic membrane movement

Treatment :

1. Local decongestants : Xylometazoline or Oxymetazoline nose drop
2. Systemic decongestants and anti-histamines : Chlorpheniramine maleate/ Cetrizine/ promethazine Hcl
3. Antibiotics if there is any associated infection
4. Medical treatment if any predisposing factors

If there is no improvement then

-         Myringotomy +/- Grommet insertion

-         Surgical treatment if any predisposing factors

Myrigotomy in otitis media with effusion – radial incision at the antero-inferior quadrant of pars tensa