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Secretory otitis media| causes, symptoms and treatment approach

Definition: Chronic non suppurative otitis media with accumulation of fluid in middle ear, resulting from obstruction of Eustachian tube or incomplete resolution of acute otitis media.

Normally, Eustachian tube (E.T) ventilates the middle ear 3-4 times per minute as it opens during swallowing and middle ear blood vessels absorb O2.

If E.T is obstructed, middle ear develops negative pressure which leads to fluid accumulation, leading to hearing loss (It is the commonest cause of deafness in children).

Causes of Secretory otitis media

  • Incomplete resolution of acute otitis media.
  • Eustachian tube obstruction: dysfunction, adenoid, nasopharyngeal tumors, cleft palate, sinusitis, rhinitis.
  • Allergy.
  • Barotrauma.
  • Radiotherapy.
    Secretory-otitis-media

Pathology

Fluid is either Mucoid: exudate by glands pr Serous transudate.

Symptoms of Secretory otitis media

  • Deafness is the main and may be the only symptom.
  • Bubbling in the ear.
  • Tinnitus.

Signs (doctor examination):

  • Retracted tympanic membrane.
  • Color: amber yellow to dull gray.
  • May be fluid level (hair line) with air bubbles.

Diagnostic investigations

  1. Hearing test: C.D, tympano gram: type B.
  2. Radiology: Xray. Or CT nasopharynx.
  3. Nasopharyngoscopy, in adults with unilateral S.O.M to exclude NPC.

Treatment of Secretory otitis media

A. Conservative treatment
  • Treatment of predisposing factors.
  • Systemic antibiotics.
  • Corticosteroids.
  • Mucolytics.
  • Nasal decongestants.
  • Valsalva maneuver.
B. Surgery
Myringotomy & insertion of ventilation tube
  • If medical treatment for 3 months fails.
  • Complications: Risk of atelectatic or adhesive OM, or cholesteatoma.
  • Permanent cause: Cleft palate or nasopharyngeal tumors; before radiation.
To drain & ventilate middle ear (M.E).

Types of ventilation tubes:

  1. Grommet (temporarily).
  2. T tube (Permanent).
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Tamer Mobarak

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