Otitis media is poorly understood by most parents. Most children come to the doctor because of ear pain, but some parents mistakenly think that their ears are better without pain and do not continue to see the doctor, resulting in delayed treatment for some children and a middle ear effusion that is difficult to cure with conservative treatment and eventually requires surgery. The following is a brief discussion of secretory otitis media in children. Otitis media in children is usually acute in onset, mostly after a cold. During the acute phase, the child may experience one or more of the following symptoms: ear pain, crying, abdominal pain, head patting, vomiting, and poor mental health. Most children develop secretory otitis media, while a very small number of children develop pus in the ear after perforation of the tympanic membrane, and some children with mild disease may recover spontaneously without treatment. Some children do not have the acute symptoms described above, but rather: older children may report stuffy ears, like something blocking them, buzzing inside the ears, hearing loss, poor academic performance, and poor concentration; younger children like to turn up the volume of the TV and are slow to respond to surrounding sounds. Secretory otitis media is caused when the eustachian tube (commonly known as the Eustachian tube, which is a tube connecting the nasopharyngeal cavity to the middle ear cavity and plays a role in regulating air pressure in the middle ear) is not open or is blocked. When the Eustachian tube is dysfunctional, outside air cannot enter the middle ear, and the original gas in the middle ear is gradually absorbed by the mucous membrane, resulting in the formation of a relatively negative pressure in the cavity, causing fluid to leak out of the mucous membrane of the middle ear into the middle ear. At first, the fluid is clear, but after a long period of time, it can become sticky, and in severe cases, “glue ear” can appear. Most cases of secretory otitis media can be cured and the hearing loss caused is mild. If the fluid in the ear is not absorbed, it can lead to secondary diseases such as adhesive otitis media, tympanosclerosis, and cholesterol granuloma, which can cause permanent hearing loss and be very difficult to treat. (Note: Many parents think that middle ear fluid is water going in through the external ear canal, but in fact it is self-generated.) The main causes of secretory otitis media in children are: acute rhinitis due to cold, allergic rhinitis, sinusitis, adenoid hypertrophy, repeated coughing from bronchitis or pneumonia, pharyngeal reflux, children with cleft palate, infants breastfeeding in the flat position, after flying, etc. In addition, inadequate doses of antibiotics, insufficient courses of treatment or drug resistance during acute otitis media can increase the chance of middle ear effusion. Common tests for otitis media: 1. Tympanic membrane appearance examination: ①Electro otoscopy: direct observation with the naked eye. In the acute stage, there is usually acute congestion, after which the tympanic membrane becomes dark red, sunken, and the light cone deforms or disappears. In a few children, fluid planes or bubbles can be seen through the tympanic membrane. If available, endoscopy can be done to get a clearer picture of the tympanic membrane through the monitor. 2. Hearing examination: ①Acoustic conductance: tympanogram is of great value for diagnosis. The flat type (type B) is a typical curve of secretory otitis media; the negative force type (type C) indicates poor function of the eustachian tube, and if the acoustic reflex and hearing are abnormal, a tympanic fluid accumulation is considered. ②Otoacoustic emission or electrical audiometry results show hearing abnormalities. ③When the child is uncooperative, brainstem evoked potential examination is feasible if necessary. 3. For those who repeatedly persist, CT examination of the temporal bone is feasible to understand the occurrence of any complications. In addition, electronic rhinolaryngoscopy can be done to understand whether there is adenoid hypertrophy. Treatment of otitis media Keeping the nasal cavity and the pharyngeal opening of the Eustachian tube open is the key to treating secretory otitis media, and the principles of treatment for this disease are to improve ventilation and remove fluid in the middle ear. Conservative treatment: Secretory otitis media is a very common disease in children, and most of them can be cured. Parents should not worry too much about it, but they should pay enough attention to it to avoid complications caused by delayed treatment. Medications can be given in the form of antibiotics, hormones, mucus dilution promoters, nasal sprays that shrink the nasal cavity, along with active rhinitis sinusitis and other diseases. If necessary, eustachian tube blowing treatment is feasible for older children. Surgical treatment: If the condition persists for more than 3 months, or if there are recurrent attacks, tympanotomy and tube placement surgery can be considered. The ventilation tube is usually left in place for 3 to 12 months, and most children can discharge the tube into the external ear canal on their own. If the adenoids are enlarged, they will need to be removed at the same time. Prevention of otitis media 1. Strengthen the body and prevent colds. When a child has a cold and nasal congestion, treat it early and use the method of blowing one side of the nose when blowing nasal snot, without excessive force, to prevent snot from entering the middle ear. 2. Children who are found to be unresponsive to sound or who demand too much volume, or who usually have heavy nasal sounds and snore during sleep should go to the hospital for examination as early as possible.