Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Female child, 4 years old, had a runny nose for almost a month in winter 2010, which was not effective when she took cold medicine and then recovered automatically. At the beginning of April, he started to have a runny nose, and at the same time, he found that he wanted to turn up the sound when watching TV. On February 19, he had acoustic impedance done at a local tertiary hospital. The diagnosis of oozing otitis media was confirmed. Oral Mucosolvan, ear drops and nasal drops were then given, and he was instructed not to use the medication for too long. The ear was no longer painful after the medication was administered. Whispering could be heard. On April 9, she was treated at the Children’s Hospital of this province, and the medication has been administered since then: cephalexin infusion for 8 days, along with nasal drip and ear drops. Later, he was given cefdinir dispersible tablets for three weeks, along with nasal drip and ear drip. The fluid in the right ear disappeared, but there was still fluid in the left ear. On May 6, he was examined at XX Hospital and saw smooth adenoid tissue protruding from the posterior wall of the nasopharyngeal apex under electronic laryngoscopy; bilateral pharyngeal fossa, pharyngeal orifice and round occipital form were clear. Impression: adenoid hyperplasia (degree II). Also: no previous use of Nesuna and Senlurbe. The doctor at the provincial children’s hospital has never said that surgery is needed, and each follow-up visit is only an otoscopy. Do I have to have a tympanic tube placed immediately in this case, or do some doctors recommend tympanocentesis and removal of the adenoids? Is it possible to continue conservative treatment in this case? Which is better, tube placement or tympanic membrane puncture? I would like to hear your opinion. Thank you! Ear, nose and throat doctor: Hello. If your child has a long-standing secretory otitis media that is recurrent, tube placement is better than puncture. If the adenoids are enlarged and compressing the Eustachian tube, surgery can be considered. Patient: Thank you, Dr. Yang! So the main question now is to rule out whether it is a secretory otitis media induced by adenoid hypertrophy? What tests do I need to do for this? If it can be determined that the adenoids are the cause, then only the adenoids need to be removed. If it is simply a secretory otitis media, tubes should be placed as soon as possible. Am I understanding this correctly? Hospital otolaryngologist: The results seen today confirm bilateral secretory otitis media. Come back for a review after one month of treatment. Patient: I’m leaving for Beijing again on Saturday, and I’m going to your clinic next Monday for a follow-up. These two weeks, I’ve been taking Genoton and drinking Centrum, but Niu Niu still can’t swallow the pills of Genoton, she always chews them, the instructions clearly state that they can’t be chewed. In addition, every time before the nasal drops are used to cleanse the nose, then spray from the xx hospital rhinitis No. 2 spray, which contains ephedrine, continuous use for two weeks is not okay? At the same time every day pinch nose blowing balloons, chewing gum, I do not know whether these measures are effective. Although it is said that the treatment is conservative for one month, and if there is no improvement, the tube will be placed, but I really can’t imagine how we should face if the tube really needs to be placed. When I think about it now, I feel very guilty and deeply blame myself. I was really careless when my child had a runny nose last winter, and I never thought it would bring such serious consequences. If my child’s hearing is affected by this, I really don’t know how I should face her. Ear, nose and throat doctor: Hello, Niu Niu’s mother. Don’t blame yourself too much first, whether it was carelessness that made your child sick. Let’s work together to try to restore your child’s hearing. Come and review the hearing first, so that you can save time. Patient: Hello, doctor! You have a normal visit next Monday (Dragon Boat Festival), right? Patient: Doctor, we went over there today, but you are off on holiday. The nurse on duty told me to see you tomorrow at 8:00 in the laryngoscopy room, and I had already bought a return ticket for this afternoon, so I will return it and prepare to go back to the hospital tomorrow. Since I don’t have any other contact information for you, I hope I can find you tomorrow. Hospital otolaryngologist: Sorry, there is no clinic today for the national holiday. You can wait for me tomorrow at 8am sharp in the ENT department on the 4th floor of the outpatient clinic. I have a major surgery all day tomorrow, so I’ll be there after I see the baby. Patient: Okay, see you tomorrow. Patient: Hello, Doctor! It’s been 20 days since my last visit to your clinic, and I feel that Niu Niu’s hearing is not abnormal and she doesn’t have a cold. Today, I took her to xx hospital and had another acoustic impedance done. The pressure in the tympanic chamber -168, volume 0.5ml, sound compliance value 0.27, sound reflex valve 1kHz, left side 118, 2kHz, right side 108, left side 110, WN110, reflex attenuation 0%; left ear type B. Does it mean that there is still fluid in the ear? Should I continue to use the medication to promote discharge? If so, how should I use them? I still have Genoton, Xanax and Nesuna at home, should I continue to use them? Patient: Would laser treatment and tympanic membrane massage also help? How come there is always fluid accumulation? Ear, nose and throat doctor: The last time we checked here was type A, right? If it becomes B or C, it means that the Eustachian tube is not functioning too well and there is negative pressure in the middle ear. You can continue to use Genoton, Xanlubai, Neshuo, and you can also use some pediatric ephedrine to spot your nose and prevent colds. Patient: The last time I was in our hospital, I did not do acoustic impedance, I just did a pure hearing test. Is it possible to ignore the acoustic impedance results, as long as the pure hearing test results show no hearing problems? Ear, nose and throat doctor: Generally, you don’t need to do it every time, but you need to review it regularly. The pure tone audiometry shows the hearing condition, and the conductive impedance shows the negative pressure in the middle ear. Sometimes there is a problem with the conductance and the audiogram may still be in the normal range and needs to be looked at together. Patient: Doctor: Hello, this is Niu Niu’s mother. I am happy to tell you that yesterday at her regular follow-up, Niu Niu’s acoustic impedance results showed that both ears are now type A. I was worried about her ears because of tonsillitis last month, so I went to do acoustic impedance, and it showed that both ears were type B. I was very anxious. Thank you very much. If it were not for you, my girl would have undergone tube placement surgery, and our family would still be suffering from the great psychological pressure and mental torture after the tube placement. Although a “thank you” is not enough to express the gratitude of my girl and my family to you, I would like to say “thank you, thank you very much” on behalf of my girl and my family. Thank you very much! Amoy is still thinking about her uncle Yang in Beijing, and yesterday, when she saw your picture, she said, “Isn’t this uncle Yang? How come Uncle Yang’s picture is here?” I will definitely take Niu Niu to see you again when I have the chance, but not for medical treatment! Hospital Ear, Nose and Throat doctor: Yes, you’re welcome, Niu Niu has recovered, congratulations!