Serous otitis media / Otitis media with effusion

Serous otitis media / Otitis media with effusion:

Serous otitis media is a condition where there is non-purulent effusion in the middle ear cleft, with the fluid being nearly sterile. 

Causes:

• Malfunctioning of the eustachian tube due to adenoid or other mass obstructing the nasopharyngeal opening and conditions like cleft palate.

• Upper respiratory tract infection or recurrent allergy episodes.

• Unresolved acute otitis media after inadequate antibiotic therapy.

Symptoms:

• Decreased hearing or ear block.

• Mild earache.

• Ear fullness.

Signs:

• Tympanic membrane may show varying degree of retraction. 

• It may appear full or slightly bulging in its posterior part due to effusion.

• Fluid level and air bubbles may be seen.

• Mobility of the tympanic membrane is restricted.

Investigations:

• Impedance audiometry shows a B-type curve.

• X-ray nasopharynx or diagnostic nasal endoscopy to examine the nasopharynx to identify the underlying pathology.

Treatment:

The main aim of treatment is to drain the fluid and prevent recurrence. Medications to relieve the blocked eustachian tube and to thin out the secretions will be prescribed. Antibiotics will be given if underlying otitis media is suspected. 

Surgical management is performed where there is long standing effusion or the medical management has been futile after trying for a period of 1 month. Surgical management includes performing a myringotomy to draining the fluid and place a grommet to keep it patent. The underlying etiological factor will also be corrected during the same procedure.