EAR - Serous Otitis Media

What is Serous Otitis Media?

Serous Otitis Media (Otitis media with effusion) is a condition characterized by the presence of non-purulent (without any pus) fluid in the middle ear cleft.

What is the aetiology of serous otitis media?

Serous otitis media is commonly seen in children. Contributing factors include:

1) Low socio-economic status and poor hygienic conditions
2) Adenoid hypertrophy and chronic tonsillitis
3) Eustachian tube malfunction
4) Palatal defects, palatal palsy
5) Allergy causing obstruction of the eustachian tube
6) Viral infections of the upper respiratory tract that stimulate excessive secretory activity
7) Unresolved acute otitis media.

What are the clinical features of serous otitis media?

Symptomatic of serous otitis media:

1) Hearing loss: It is insidious in onset and may be diagnosed by audiometry.
2) Earache: This is due to stretching of the tympanic membrane.

Signs on examination:

1) Tympanic membrane is often dull with loss of light reflex
2) Tympanic membrane may appear bulging with air bubbles
3) Mobility of tympanic membrane is reduced

What investigations are required for the diagnosis of serous otitis media?

1) Tuning fork tests: They show mild to moderate conductive hearing loss
2) Pure tone audiogram shows conductive hearing loss up to 35-40 db
3) Impedance audiogram: Middle ear fluid causes reduced compliance with flat curve

What is the treatment of serous otitis media?

Medical treatment:

1) Local decongestants (Nasal drops such as Oxymetazoline, Xylometazoline)
2) Antihistaminics
3) Antibiotics
4) Valsalva's manouvre and steam inhalation for middle ear aeration.

Surgical treatment:

1) Myringotomy
2) Grommet insertion
3) Cortical mastoidectomy may be required for removal of thick fluid from mastoid antrum.

What are the complications of chronic secretory otitis media?

The complications of chronic secretory otitis media include:

1) Ossicular necrosis
2) Retraction pockets
3) Cholesterol granuloma due to stasis of fluid in middle ear and mastoid
4) Surgical complications of myringotomy and cortical mastoidectomy.

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