Secretory otitis media
Denomination
• Otitis media with effusion
• Exudative otitis media
• Mucoid otitis media
• Catarrhal otitis media
• Tubotympanitis
• Non-suppurative otitis media
• Secretory otitis media(分泌性中耳炎 )
Pathology
Middle ear effusion
Serofluid 、 Mucus 、 Sero-mucous , non
blood or CSF
Epithelium mucosae thicken , Epithelial
metaplasia
Pseudostratified columnar ciliated epithelium
Secretory epithelium
Epidemiology
• Main in children
– 5.2-21.6% ( by aural speculum , Hongkong), 7.3-30.7%
( by acoustic impedance , Hongkong ) in 2-7 year-old
– 15-40% ( 2004 , USA ) in 1-5 year-old
– 3.8% in 2 year-old , 1.1% in 11 year-old ( Suarez Nieto , 1983 ,USA)
• More than 50% infant occurs , most natural cure in 3
months
Etiology
• Eustachian tube dysfunction
– Eustachian tube blockage
– Ciliary dysfunction
• Infection
• Immune reaction
Eustachian tube dysfunction
• Disease in pharynx nasalis– Adenoidal hypertrophy
– Nasopharyngeal carcinoma
• Tumour from parapharyngeal space
Cleft Palate
Cartilage of eustachian
tube problem
Eustachian tube dysfunction
• Rhinosinusitis
• Nasal polypus
Eustachian tube dysfunction
Infection
• Germ in excretion of middle ear ( Senturia , 1958)• 22-52% positive in excretion of mid ear
• Hemophilies influenzae ( 14.7% , USA ) and
micrococcus pneumoniae ( 7.0% , USA ) are the
main pathogenic bacterium
• Also influenzavirus 、 adenovirus 、 chalmdiae
trachomatis
Immune reaction
• Type I
– Allergic rhinitis
– Nasal polyp
– Bronchial asthma
• Type III
– Bacterium in adenoid and pharynx oralis
Clinical manifestation
• Common cold
• Hearing disturbance
• Earache
• Aural fullness
• Tinnitus
Objective sign
• Ear drum
– Hyperemia
– Mobility diminished
• Cavum tympani
– Fluid
– Air bubbles
• Pure tone test
– Conductive hearing loss
Objective sign
Objective sign
Combined deafnessBacterium or toxin reach inner ear by RWMHC hurt
Objective sign
• Acoustic impedance
– Type B : typical plot
– Type C : eustachian tube dysfunction
Differential diagnosis
• Nasopharyngeal carcinoma
– Unilateral secretory otitis media , adult , lump in neck ,epistaxis
– Epipharyngoscope , CT , MRI
• Cerebrospinal otorrhea
– Trauma or congenital deafness
– Temporal bone CT
• Perilymphorrhea
– Stapes operation , sudden deafness
– Tullio phenomenon
• Cholesterol granuloma
– Sequela of secretory otitis media
– Dark blue eardrum
– Temporal bone CT
Differential diagnosis
Treatment
• Spontaneous cure
• Etilogical treatment
– Adenoidectomy
– Tonsillectomy
– FESS
Treatment
• Drug treatment– Antibiotic
– Glucocorticosteroid
– Decongestant
– Ambroxol
Treatment
• Eustachian tube inflation
Treatment
• Tympanocentesis
Both diagnosis and treatment
Treatment
• Tympanocentesis
– Surface anesthesia
– Only adult
– Asepsis
– Complication
infection,impairment of RWM
auditory ossicle
fenestration oval window
Treatment
• Myringotomy– Cutter knife
– Carbon or Dioxide laser
Treatment
• Grommet insertion
Treatment
• Grommet insertion
– Indication
inefficacy of myringotomy
glue ear
hearing loss : 40db
Complication
– Tympanosclerosis
– Permanence perforation of ear drum
– Chronic suppurative otitis media
– Sensorineural deafness
Thanks!
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