Anatomy of the ear
- The outer ear, including the auricle and external auditory canal, serves to collect sound in the auditory system.
- Middle ear The middle ear, between the middle ear and the inner ear, is the main organ for conducting sound and includes four parts: the tympanic chamber, the eustachian tube, the tympanic sinus, and the mastoid process.
- The inner ear, also known as the vagus, is divided into a bony vagus and a membrane vagus, and contains auditory and locus coeruleus receptors.
The concept of secretory otitis media
- It is an inflammatory disease that occurs in the middle ear.
- It is an inflammatory disease of the middle ear characterized by fluid accumulation in the middle ear (including plasma, mucus, and plasma-mucus) and hearing loss.
- There are two types of inflammatory diseases: acute and chronic. It can be caused by acute otitis media that has not been treated in a timely and appropriate manner or by the recurrence, prolongation and transformation of acute otitis media.
The figure below shows the tympanic membrane of a case of secretory otitis media, in which bubbles are visible through the tympanic membrane, indicating that there is fluid in the tympanic chamber
This picture is similar, but the nature of the effusion is different. This often indicates that the effusion is mucous or mucopurulent.
The following picture shows the tympanic membrane of a case of chronic secretory otitis media. The tympanic membrane is opaque, like hairy glass, and there are dilated microvessels in the tense part of the tympanic membrane, suggesting that the fluid in the tympanic chamber is very viscous.
Onset of secretory otitis media
- It is one of the most important causes of deafness in children. 70% of cases occur under the age of 4 years and have a significant impact on the speech, language and cognitive development of infants and children.
- The incidence is on the rise, reaching 27% in 2006. It is a common and frequent disease in the otolaryngology department of children and toddlers.
- According to statistics, 70% of children under 5 years of age have had otitis media once.
Causes of secretory otitis media
1. Malfunction of the eustachian tube due to various causes
- Chronic sinusitis, rhinitis
- Adenoid hypertrophy
- Chronic tonsillitis, tonsillar hypertrophy
- Cleft palate
2.Allergic rhinitis, allergic reactions in the upper respiratory tract
3, upper respiratory tract infections and viral infections of the upper respiratory tract, some acute infectious diseases such as measles, influenza can be induced
Symptoms and signs of secretory otitis media
- Ear blockage, stuffiness, distant hearing, enhanced self-hearing
The symptoms can be temporarily relieved by swallowing or yawning, and a blistering sound can be detected in the middle ear when the nose is pinched and the air is puffed.
- In infants, the symptoms are poor sound response; in older children, the symptoms are poor concentration in class and the need to adjust the volume of television.
- Electro otoscopy reveals a light red or orange tympanic membrane with bubbles or fluid planes. In chronic cases, the tympanic membrane is milky white or grayish-blue, opaque, like hairy glass, with dilated microvessels in the tense part of the tympanic membrane.
Treatment of Secretory Middle Ear Inflammation
- The principles of treatment are to remove fluid from the middle ear, improve the function of the eustachian tube, and eliminate the cause of the disease.
Internal treatment:
- Antibiotics should be used early and in adequate doses until the effusion disappears and the tympanic membrane and hearing return to normal. The average duration of treatment is 7 to 14 days.
- Antihistamines, systemic H1 receptor antagonists can be used
- Nasal drops, 0.5% ephedrine drops, to promote the contraction of the mucous membrane of the nasal cavity and the eustachian tube, which is conducive to middle ear ventilation and drainage; treatment of primary diseases such as sinusitis, adenoiditis treatment or removal of adenoid hypertrophy
Surgical treatment
-Tympanic membrane aspiration and drug injection, suitable for thin tympanic fluid accumulation
-Tympanotomy and placement of a middle ear ventilation tube, especially for glue ear, can be considered for those who are not effective with medical treatment or for chronic cases.
Special note.
Participatory otitis media is an inflammatory disease of the middle ear characterized by middle ear effusion and hearing loss. It is one of the most common causes of hearing loss in children, as middle ear effusion will limit the vibration of the tympanic membrane and affect the structure of the middle ear, resulting in hearing impairment, especially over time, the middle ear effusion will gradually become viscous and become glue ear, causing severe hearing loss. Childhood is a critical period for hearing and language development, if there is a hearing disorder will have a certain impact on the infant’s intellectual development, some are mistaken for autism, for older children and school-age children will cause a great impact on their learning, should cause us enough attention.