Secretory otitis media is a non-suppurative inflammatory disease of the middle ear characterized by fluid accumulation in the tympanic chamber and hearing loss. In children, due to the lack of other obvious symptoms, the main description is often unclear, and some of them are already in the middle and late stages when parents find that their hearing is affected. Secretory otitis media can be called the invisible killer of pediatric hearing.
The nature of the fluid in the tympanic cavity of secretory otitis media can be either plasmacytically leaking or exudative, or mucus. There is no uniform clinical nomenclature for this disease, which is referred to as exudative otitis media, catarrhal otitis media, plasmacytoid otitis media, plasmacytoid-mucus otitis media, non-suppurative otitis media, and tympanic effusion. When the middle ear is thick and gelatinous, it is called glue ear. Studies have found that the incidence of otitis media in children is extremely high, with approximately 90% of preschoolers in the United States and 25% of school-age children having otitis media.
The etiology is thought to be related to eustachian tube dysfunction, infection, and immune response.
Clinical presentation
The most common clinical manifestations of secretory otitis media are a feeling of stuffiness or blockage in the ear, hearing loss, and tinnitus. Hearing loss can change with body position and can be accompanied by ear pain, tinnitus, and the sound of water can be heard by shaking the head.
1, hearing loss: hearing loss, self-hearing enhancement. Hearing can be temporarily improved when the head position changes (change of position hearing improvement). When fluid accumulation is severe or sticky, hearing may not change due to head position change. Children also often show a slow response to sound, lack of concentration, decreased academic performance, and always turn up the sound when watching TV or using hearing devices.
2. Earache: Acute patients may have mild earache, which may be persistent or throbbing, and may be temporarily relieved by pressing on the ear screen. Child patients or chronic patients often complain that the ear pain is not obvious.
3. Tinnitus: It is mostly low-pitched and intermittent, such as “popping” sound, buzzing sound and running water sound. When the head moves or when yawning or blowing the nose, the sound of air passing through water can appear in the ear.
Auxiliary examinations
Tympanic otoscopy or microscopic examination
Tympanic otoscopic examination of the loose part of the tympanic membrane or total tympanic membrane invagination, manifested as shortening, deformation or disappearance of the light cone, posterior and superior displacement of the hammer bone stalk, obvious protrusion of the short protrusion of the hammer bone, small angle of the anterior and posterior folds, and restricted movement of the tympanic membrane. The tympanic membrane loses its normal luster and becomes single yellow, orange-red, oily or amber in the presence of fluid, and the light cone is deformed or displaced. In addition, air-fluid planes and bubbles can be seen through the tympanic membrane. In chronic cases, the tympanic membrane may appear grayish or milky white, and the whammy bone stalk is embossed.
Acoustic conductivity test
The tympanic chamber pressure map of the acoustic conductance can be type B and type C. In the beginning when the eustachian tube is malfunctioning or blocked, middle ear gas is absorbed to form a negative pressure in a C-shaped curve. As the lesion progresses and fluid builds up in the tympanic cavity, it becomes a B-shaped graph without peaks. It is important to note that a tympanogram with a conventional 226 Hz sound probe test can only reflect middle ear function in infants over 6 months of age; infants younger than 6 months of age need to use a higher frequency sound probe (1000 Hz).
Temporal bone high-resolution thin-layer CT
High-resolution thin-section CT of the temporal bone provides a picture of the middle ear and allows observation of the nasopharynx and parapharyngeal space for occupancy.
Tympanocentesis or tympanotomy
Under the otomicroscope or endoscope, the tympanic membrane is punctured or incised underneath the anterior tympanic membrane, and plasma-like or mucus-like fluid is seen. However, tympanocentesis or tympanotomy can not only clarify the diagnosis, but also achieve the treatment purpose, which is the golden indicator in clinical diagnosis.
Nasopharyngeal examination
The nasopharynx and the pharyngeal opening of the eustachian tube are directly observed by nasal endoscopy to rule out occupying lesions in the nasopharynx. This method is used relatively more often in adults or older children.
Diagnosis
Based on the medical history and specialist examination, combined with otomicroscopy or endoscopy, tympanic chamber conductance mapping, tympanocentesis or dissection, and CT, the diagnosis can be clarified.
Treatment
Removal of middle ear fluid, improvement of middle ear ventilation and drainage and etiological treatment are the principles of treatment for this disease.
I. Close observation and follow-up
Because pediatric secretory otitis media is a self-limiting disease with a certain rate of self-healing, children should be treated conservatively and closely observed for a certain period of time before invasive treatment is given. Regular review with pneumatic otoscopy and tympanogram should be performed.
Remove middle ear fluid and improve middle ear ventilation and drainage
1. Keep the nasal cavity and the eustachian tube unobstructed.
2. Blowing of the eustachian tube.
3. Tympanic membrane aspiration and drug injection.
4.Turmpanotomy.
5.Tubular placement.
Active treatment of nasopharyngeal or nasal cavity diseases such as adenoidectomy, sinusitis, etc. If the tonsils are particularly enlarged and related to the recurrence of secretory otitis media, tonsil removal should be performed.
IV. Antibiotics or other synthetic antibacterial drugs.
V. Short-term oral glucocorticoid drugs.