Secretory otitis media is a non-suppurative inflammatory disease of the middle ear characterized by fluid accumulation in the tympanic cavity and hearing loss. The fluid in the middle ear can be either plasmacytically leaking or exudative, or mucus. The name of the disease is not uniform, but it is called exudative otitis media, catarrhal otitis media, plasmacytoid otitis media, plasmacytoid-mucus otitis media, and nonsuppurative otitis media. The middle ear is called glueear if it is thick and sticky.
Secretory otitis media can be divided into two types: acute and chronic. Chronic otitis media can be caused by not receiving timely and appropriate treatment during the acute phase, or by repeated attacks and delays. The disease is common in winter and spring. It can occur in both children and adults and is a common cause of deafness in children.
Etiology
The cause of deafness is not completely clear. The main causes are thought to be pharyngeal dysfunction, infection, and immune response.
Clinical manifestations
The most common symptoms are a feeling of stuffiness or blockage in the ear, hearing loss and tinnitus. It often occurs after a cold, or unconsciously. Sometimes the hearing can be improved by changing the head position. There is self-hearing enhancement. Some patients have mild ear pain. In children, hearing is often dull or inattentive.
Diagnosis
Tympanic membrane invagination, manifested by shortened, scattered or absent light cones, markedly protruding short hamate bones, horizontal hamate stalk, and marked anterior and posterior folds. The tympanic membrane is pink or yellow, yellowish and oily, and the fluid plane can be seen through the tympanic membrane. This fluid plane is a hair-like arc-shaped line, called the hair line, and this fluid plane remains horizontal when the head position changes. Sometimes bubbles in the fluid can be seen. In chronic cases, the tympanic membrane is thickened and cloudy and dark. Restricted tympanic membrane mobility is seen on tympanic otoscopy. Diagnostic tympanocentesis can be performed aseptically if necessary to confirm the diagnosis.
Audiological examination: tuning fork and pure tone audiometry are mostly conducted deafness. Acoustic impedance-conductance testing of the tympanic chamber shows a flat (type B) or high negative pressure (type C) conductance map, which helps in the diagnosis.
Treatment
(i) Improvement of middle ear ventilation
1.1% ephedrine solution or furacilin ephedrine solution, chloramphenicol ephedrine solution nasal drops.
2.Pharyngeal tube blowing: pinch nasal puffing method, pharyngeal water ventilation method or catheter blowing method can be used. Not to be used when combined with acute upper respiratory tract infection.
3. Infrared or ultra-short wave heat-transfer physiotherapy to improve blood circulation in the middle ear and promote the decreasing of mucosal edema.
(ii) Removal of middle ear fluid.
1. Tympanic membrane puncture and aspiration.
2. tympanotomy.
3. Tympanoplasty.
(iii) Etiological treatment.
1. Active treatment of nasopharyngeal or nasal cavity diseases: adenoidectomy for adenoid hypertrophy, for example. If the posterior end of the inferior turbinate is enlarged, partial resection of the posterior turbinate is performed.
2.Antibiotic treatment: antibiotics (penicillin, vincristine, levofloxacin) can be used in the acute stage to prevent or control infection.
3, steroid hormone drugs: Dexamethasone or prednisone can be used orally for short-term treatment.