1. What is secretory otitis media? Secretory otitis media is a non-suppurative inflammatory disease of the middle ear characterized by conductive deafness and fluid accumulation in the tympanic cavity. 2.What is eustachian tube dysfunction? The middle ear cavity is connected to the nasopharyngeal cavity through the eustachian tube, through which air enters the middle ear and plays a role in maintaining normal pressure in the middle ear cavity. Eustachian tube dysfunction can lead to negative pressure in the middle ear cavity, resulting in non-suppurative inflammation. 3.What causes eustachian tube dysfunction? Eustachian tube dysfunction includes mechanical obstruction, muscle weakness and poor cartilage elasticity, etc. Eustachian tube cilia dysmotility is also a cause, which is why the incidence of secretory otitis media is extremely high after radiotherapy for nasopharyngeal carcinoma. This is why the incidence of secretory otitis media is significantly higher in children than in adults. Chronic rhinitis and sinusitis, deviated nasal septum are also common causes, and the change in air pressure when riding in an airplane or high-speed elevator can also cause secretory otitis media. It is especially important to note that adults with unilateral secretory otitis media need to check the nasopharynx to rule out the possibility of nasopharyngeal cancer. In some cases, patients with nasopharyngeal cancer only have secretory otitis media without other clinical symptoms, so it is necessary for physicians with adult secretory otitis media to have patients undergo rhinoscopy. 4. Why does obstruction of the eustachian tube cause otitis media? When the eustachian tube is blocked, the outside air cannot enter the middle ear, the original gas in the middle ear cavity is gradually absorbed by the mucosa, negative pressure is formed in the middle ear, the vascular permeability of the middle ear mucosa increases, leakage fluid appears, and fluid accumulates in the middle ear cavity. This fluid is exuded by the middle ear mucosa, not water in the ear. When many parents hear that their child has fluid in the middle ear, they will say that we are very careful in the bath and there is no water in the middle ear. Note that this has nothing to do with water in the ear. Over time, the fluid in the middle ear cavity will become gradually sticky, like a paste, called glue ear. 5. What are the manifestations of secretory otitis media? Hearing loss and ear congestion are the main clinical manifestations. However, there are often no complaints in children. Sometimes parents will find that their children will only seek medical attention when they watch TV at a loud volume, ignore calls to him, or lose concentration. More often, they visit the doctor because of acute otitis media ear pain and are found to have secretory otitis media by the physician. 6. What are the changes in the eardrum of patients with secretory otitis media? Due to the negative pressure in the middle ear, the tympanic membrane can be significantly invaginated, and sometimes you can see the liquid flat or bubbles in the middle ear cavity. 7. What is an acoustic conductance test? What do the results tell me? Acoustic conductance resistance is a method of testing middle ear pressure. Pressure is applied to the eardrum in the external auditory canal. In normal people, the pressure gradually rises, and then the eustachian tube opens and the pressure drops, showing a spike-type graph with a peak around 0. Secretory otitis media shows that the pressurized eustachian tube does not open and shows a flat type curve, or the peak is shifted to the left. 8. How to distinguish between secretory and purulent otitis media? Secretory otitis media often has no ear pain, no pus flow, and no tympanic membrane perforation, so it is still easy to distinguish from purulent otitis media. 9. What is the treatment for secretory otitis media? For acute secretory otitis media, which often occurs secondary to forceful nose blowing, after an airplane ride or after a cold, nasal drops need to be used. The use of other drugs such as antibiotics, hormones, and cilia-promoting drugs is not conclusive at this time. In adults, tympanic membrane aspiration is possible, but in children, tympanic membrane aspiration is not recommended, and conservative treatment is still recommended. In chronic otitis media, a distinction needs to be made between children and adults. In adults, repeated pumping of fluids with regular medication is not effective, and the nasopharynx should be examined and the nasal cavity should be treated. In children, I generally do not recommend long-term use of nasal drops during the chronic phase, but encourage more chewing to promote the function of the eustachian tube, and consider tympanic tube placement if it is not good for three consecutive months. About half of the patients will get better after chewing gum, and the other half need surgery. I always say to my patients that if it will get better, it will naturally get better without medication; if it will not get better, it will not get better with medication; therefore it is recommended to observe to see which direction the otitis media goes. 10.When should surgery be performed for secretory otitis media? Surgical pointers for secretory otitis media 1. relatively asymptomatic 2. poor results of conservative treatment 3. duration of disease longer than 3 months if occurring bilaterally or longer than 6 months if occurring unilaterally 4. early placement of tubes is required if 1) significant hearing loss (25dB or more) 2) delayed speech and language development 3) significant invagination of the tympanic membrane 4) balance disturbance or vertigo 5) persistent tinnitus. In recurrent otitis media, the duration of each attack is not sufficient for chronicity, but the sum of the attack duration can be on the chronicity criteria. Presence or suspicion of suppurative otitis media with persistent ear leakage during tympanic membrane puncture or incision. What are the surgical options for secretory otitis media? Tympanic membrane puncture, tympanic membrane laser perforation, tympanic membrane placement 11. In what cases is pharyngeal balloon dilation necessary? Balloon dilation can be considered for chronic eustachian tube dysfunction, such as recurrence after repeated tube placement or persistent clinical manifestations of eustachian tube dysfunction with poor medication even without tympanic fluid; presence of tinnitus, hearing loss, balance disturbance or vertigo; need for hyperbaric oxygen therapy; middle ear sclerosis with or without internal pouch and poor medication; poor eustachian tube function after tympanoplasty. 12.What is the cost of eustachian tube balloon dilation? Will it be good to put it once? For this procedure alone, it costs about 10,000 RMB 13.How long does it take to recover the function of the eustachian tube after tympanoplasty? Generally, the function of the eustachian tube can be recovered in a few weeks. 14.What ways can improve the ventilation function of the eustachian tube? You should avoid blowing your nose hard and chewing gum more often.