In the early stage of otitis media (within 3 months), medication is mainly used to treat underlying diseases such as cold, rhinitis, sinusitis, adenoid hypertrophy, etc. Generally, otitis media can gradually recover after the nasal symptoms improve. At the same time, we use mucus-promoting drugs to help the eustachian tube discharge middle ear fluid. During the treatment process, we should reduce the occurrence of cold and flu to avoid affecting the middle ear fluid drainage. How long does it take to recover from otitis media? This is the question that all ENT doctors are most afraid to answer. Generally speaking, otitis media treatment takes a long time, as little as 2 weeks or more than 3 months, and is closely related to the nasal symptoms, as each person’s health condition and anatomical development vary in the amount of fluid that accumulates, so there is no way to predict the exact course of treatment. What is predictable, however, is that if there is still fluid in the middle ear for more than 3 months, surgery is recommended. Depending on the child’s condition, surgery may be performed earlier if there is already hearing loss, adenoid hypertrophy, or if there is no improvement with medication. Tympanic membrane Auditory chain Eustachian tube Middle ear effusion Middle ear effusion, in the early stages, is mostly inflammatory exudate that cannot be eliminated for a long time, and the middle ear secretes large amounts of protein and other macromolecular substances, resulting in a viscous effusion that is more difficult to drain. When middle ear fluid is viscous, the movement of the auditory chain is weakened, and the sound transmission function is also weakened, resulting in hearing loss. When the consistency reaches a certain level, it is called glue ear, a condition in which it is no longer possible to surgically remove the fluid, and it also causes permanent hearing loss. It takes about 3 months to evolve from clear fluid to glue ear, so surgery within 3 months is recommended. The principle of surgery for secretory otitis media is relatively simple. Since the mucus cannot be drained from the nasal cavity through the eustachian tube due to the blockage of the eustachian tube, a ventilation tube is installed in the tympanic membrane to drain the mucus through the tympanic ventilation tube. Therefore, it is normal for the ear to run after surgery. Since the tympanic ventilation tube connects the middle ear directly to the outside world, the ear should be strictly water-prohibited after surgery to prevent bacteria from entering the ear and causing artificial otitis media or even purulent otitis media. Of course, swimming is also not allowed. The tympanic ventilation tube will usually fall off automatically in 3-6 months, or if not, it can be removed after 1 year. In case of recurrent otitis media, long-lasting tubes may be considered and placed for a longer period of time. The tympanic membrane will be traumatically perforated after dislodgement and will need to be reviewed periodically to allow the perforation to fully grow back before swimming. The first picture shows the tympanic ventilation tube, which drains the mucus through the ventilation tube, not the eustachian tube. The second and third pictures show the middle ear effusion, where you can clearly see the fluid and air bubbles in the tympanic membrane. Of course, the pictures are only examples of very typical cases, but most of the time they are not so typical and require the doctor’s experience, the child’s clinical manifestations and the auxiliary examinations to determine. Fluid in the middle ear usually does not cause significant discomfort, and secretory otitis media only has ear pain in the early stages, which is relieved after a few hours, and then usually no longer has any sensation. Some children with strong verbal skills may describe it as stuffy ears, ear swelling, buzzing, etc., none of which is very intense. In children with atypical tympanic membrane patterns, a tympanogram is needed to assist in determining whether there is fluid accumulation. This is also known as an acoustic conductance test. Figure 1 is a normal tympanogram, also known as type A, which can be simply interpreted as having a crest, while Figure 2 is a type B diagram, which means that there is no crest, indicating that the tympanic membrane does not move well during pressure changes. The tympanic membrane moves poorly when there is fluid in the middle ear. Of course, there are rare cases where the tympanic membrane itself is the cause of the B pattern, and this can be ruled out by adding a DPOAE. With otitis media, as the middle ear fluid is gradually absorbed and eliminated, negative pressure will appear in the middle ear cavity, which is a sign of gradual recovery, and the tympanogram will appear as a C-shaped chart, i.e., the peak of the wave is not in the middle but on the left side of the negative value. Treatment of otitis media requires regular review to monitor the drainage of fluid from the middle ear to determine if continued medication is needed.