Secretory otitis media, also known as catarrhal otitis media, non-suppurative otitis media, exudative otitis media, plasmacytoid otitis media, mucus otitis media, plasmacytoid-mucus otitis media, middle ear effusion, mucus ear, glue ear, etc. Since the physiopathology of children is different from that of adults, children with secretory otitis media before the age of 14 belong to the category of “childhood secretory otitis media” in this article. The peak incidence of otitis media in children is in the preschool years (2-6 years old). It has been reported that more than 84% of children in the southern United States have had otitis media, 50% have had three or more episodes, and a quarter have had six or more episodes. Secretory otitis media is the most important cause of hearing loss in children.
I. Etiology of secretory otitis media in children
Due to the poor immune function of children compared to adults, the susceptibility to upper respiratory tract infections during childhood, and the characteristics of the children’s eustachian tube and breastfeeding factors, secretory otitis media is more likely to occur in children than in adults. Its common etiology is as follows.
1, nose and throat lesions: cold, allergic rhinitis, chronic rhinitis, acute and chronic sinusitis, tonsillitis, can cause inflammatory obstruction of the eustachian tube and the onset; pediatric physiological adenoid hypertrophy, or due to a longer period of rhinopathy resulting in inflammatory swelling and hypertrophy of the adenoids, compression of the eustachian tube, causing otitis media.
2. Inadequate immune function: Immune function of children is not mature. Before children are about 3 years old, their immunity mainly comes from their mother, but after 3 years old, they are greatly depleted, and their own immunity is not strong. Chinese medicine believes that “the righteousness of the qi exists within, the evil cannot dry up”, and “where the evil plays, its qi must be deficient”, due to “body deficiency” and “deficiency of the righteousness of the qi “Therefore, it is easy to have repeated illnesses. The following understanding of Western medicine regarding the etiology of otitis media is often related to this: non-mechanical obstruction of the eustachian tube: the weakness of children and repeated infections of the upper respiratory tract lead to a decrease in the tension of the eustachian tube (poor elasticity of the cartilage of the eustachian tube, or a decrease in the level of active substances on the surface of the eustachian tube), so that the eustachian tube is always in a closed, collapsed state and cannot open properly, resulting in functional obstruction and leading to otitis media. Insufficient defense function of the mucosal epithelium of the eustachian tube: Due to weakness and poor immunity, the mucosal epithelium of the eustachian tube has insufficient excretion function for harmful substances, which easily leads to otitis media. Hypotoxic infection: When the immune function is not strong, harmful bacteria entering the eustachian tube and the middle ear cavity may exist for a long time, but no significant inflammatory appearance will occur, but lead to the existence of long-term chronic inflammation in the middle ear cavity and the eustachian tube.
3. Incorrect breastfeeding method: The eustachian tube of adults is “thin – long – rising”, so it is difficult for bacteria to invade; while the eustachian tube of children is “wide – short – flat”, which is easily invaded by bacteria. If the baby is lying flat when breastfeeding, the milk inhaled at this time will easily go up through the throat and enter the eustachian tube. Therefore, infants should not suckle too fast (the opening of the pacifier should not be too large) when suckling (especially when suckling milk substitute). If the baby’s body position is flat when burping, it is likely that the milk will enter the eustachian tube through the nasopharynx, leading to otitis media (because bacteria are usually present in the mouth and throat, which will contaminate the milk to some extent). Therefore, the basic requirements for the correct method of breastfeeding are: the baby sucks milk in a basic sitting position, the speed of sucking should not be too fast, and after eating it is advisable to move properly so that the air in the stomach is expelled (you can pat the back to help burp out) before lying down to sleep.
4. Allergic reaction: Allergic inflammation can occur in the middle ear, leading to susceptibility to secretory otitis media with difficulty in healing or repeated aggravation. Some studies have shown that more than 74% of patients with secretory otitis media can be combined with allergic reactive causes. Children with a family history of allergic reactions, or who have allergic diseases of their own, are susceptible to otitis media.
5. Sudden change in air pressure: If you travel by airplane when you have nose and throat disease, you are prone to develop secretory otitis media. See article for analysis of the mechanism.
6. Otitis media: How to treat non-suppurative otitis media
What is the manifestation of secretory otitis media in children and how to diagnose it?
1.Main symptoms
The main symptoms of secretory otitis media, in adults, are hearing loss, ear pain, a sense of occlusion in the ear, and tinnitus. However, since children do not express themselves, the younger they are, the less they can express themselves, so although they have symptoms, they do not necessarily speak about them, and it is even more difficult to express them in a timely manner. In the following cases, parents should learn more about the child’s condition and sometimes need to see a doctor as soon as possible or take the doctor’s advice for necessary tests.
(1) For children who are a few years old, if they ask to turn up the volume when watching TV, it indicates a possible hearing loss; if they are listening in class and have difficulty hearing the teacher when they are seated back, it indicates a possible hearing loss. Should promptly see a doctor.
(2) Children who actively talk about ringing in the ears (tinnitus), or who actively talk about ear pain, are likely to have otitis media and should see a doctor promptly.
(3) If an infant before the age of three always tries to scratch his or her ear with his or her hands, it is likely that there is something wrong with the ear, possibly some kind of ear discomfort caused by otitis media, and a doctor should be consulted promptly.
(4) In the case of the above-mentioned causes, especially if there are significant nose and throat pathologies, if any of these conditions occur, it is likely that otitis media has occurred and a doctor should be consulted promptly.
2. Examination
The key to determining whether there is a secretory otitis media is to do an acoustic impedance (acoustic conductance) test in children.
For those who can cooperate after the age of 3, electrical audiometry can also be done.
Video otoscopy can sometimes provide a definitive diagnosis when there is significant middle ear effusion.
If the disease is of long duration, a CT examination may be required for clarification.
How to treat otitis media in children
The principles of treatment for children with secretory otitis media are: active treatment of the cause, strengthening the drainage of the nasal cavity and the eustachian tube (which helps inflammation to eliminate fluid and inflammation), eliminating fluid and inflammation in the middle ear, and preventing middle ear adhesions (to avoid the formation of permanent hearing loss). Its main treatment methods are as follows.
1. Etiological treatment
(1) Acute rhinopathy: common ones are acute rhinitis and acute sinusitis: Chinese medicine or western medicine have good effect on acute rhinopathy. Mainly the reasonable use of antibiotics, and with decongestants and anti-inflammatory nasal drops.
(2) Chronic rhinopathy: the common ones are chronic rhinitis, sinusitis and allergic rhinitis. According to different nasal diseases, appropriate non-surgical treatments are used mainly. For the comparison of the effects of Chinese medicine and Western medicine, these nasal diseases are generally better treated with Chinese medicine, sinusitis can be combined with replacement therapy, and allergic rhinitis can be combined with anti-allergic western medicine taken orally. At the same time, it is advisable to cooperate with decongestants, anti-inflammatory agents (mainly sinusitis), and hormonal (all three nasal diseases are appropriate) spray (drops) nasal.
(3) Adenoid hypertrophy: From the western medical point of view, in principle, it is advocated to remove the adenoids in order to release the pressure on the pharyngeal orifice of the nasopharynx and accelerate the improvement and cure of otitis media. From the clinical point of view, we can also consider conservative therapy as the main treatment (mainly Chinese medicine, or Western medicine, or a combination of Chinese and Western medicine), and then consider surgical removal of the adenoids if the effect is not obvious for more than three months. Realistically, most Western hospitals recommend surgical removal, but personally, it seems to be somewhat problematic. In this regard, please refer to the article.
(4) Pediatric pharyngology: How to treat adenoid hypertrophy.
(5) Pediatric rhinopathy: Is surgery necessary for children with sinusitis tonsillar adenoid hypertrophy secretory otitis media…
(6) Immunity is not strong, easy to catch a cold: appropriate with the taking of immunity-enhancing drugs. There are many such drugs. See reference article.
2.Anti-inflammatory treatment
(1) Oral hormone: Prednisone is commonly used. Acute secretory otitis media or fluid in the middle ear can be used, usually for 3-5 days only.
(2) Oral antibiotics: Commonly used drugs are oral amoxicillin clavulanic acid potassium, azithromycin, etc. From a Western medical point of view this is very necessary, but in fact mainly for the acute course of the effect is better. The author belongs to Chinese medicine, for acute disease, or with anti-inflammatory drugs as appropriate (generally less), but for chronic people tend to use only Chinese herbal medicine to identify and treat.
(3) Respiratory mucosal pro-discharge agents: commonly used drugs are standard myrtle oil enteric capsules (Genotone) and eucalyptus lemongrass enteric soft capsules (Chenault). If necessary, they can be taken continuously for 1-3 months. If the effect is not good for three months, it means its effect is limited and can be discontinued. Its main function is to promote the excretion of middle ear mucosa, which is conducive to the improvement and elimination of inflammation.
3.Promote the drainage of nasal and eustachian tube
(1) Decongestant nasal drops: and make the medicine flow into the nasopharynx, so as to play the role of smooth nasal cavity and open the pharyngeal opening of the eustachian tube. Because it needs to be used for a longer period of time, it can be used once a day at night, with three days then stop three days, or with a day then stop a day, that is, long-term use (some doctors also advocate the use of five days stop two days). Not every day continuous use, it can prevent the side effects of decongestant-induced drug rhinitis.
(2) Anti-inflammatory agent nasal drops: play a direct therapeutic role in eliminating inflammation in the nasal cavity and nasopharynx. It is necessary to make the medicine flow into the nasopharynx.
(3) Hormonal nasal spray: If there is adenoid hypertrophy, or if there is nasal disease, it can be used in conjunction. Generally, it can be used once a day, every day continuously.
4.Surgery and other treatments
(1) Tympanic membrane puncture: suitable for those with effusion, for pediatric patients, generally need to be performed under general anesthesia; however, after puncture and fluid extraction, there is a possibility that the effusion will reappear soon, so it is generally not considered. In older children (over 12 years old), general anesthesia is not necessary and can be considered.
(2) Tympanic tube placement: This is usually done under general anesthesia. The main purpose is to incise the tympanic membrane and place a drainage tube so that the fluid in the middle ear cannot accumulate, and keep the tube in place for six months to a year. During the tube placement period, care needs to be taken to protect the ear from sewage, and a small number of people may have a complication of suppurative otitis media as a result. It is also possible to perform laser perforation of the tympanic membrane only to facilitate drainage.
(3) Tympanic membrane massage and eustachian tube blowing: Older children can massage the tympanic membrane and chew gum on their own (with similar effects as the adult eustachian tube blowing on its own). Methods see reference article.
5.TCM evidence-based treatment has certain advantages
(1) Chinese medicine diagnosis and treatment is mainly based on soup (tablet decoction; or Chinese medicine granules taken with boiling water), which can be used to treat the patient’s current condition with a full range of medication at the same time.
(2) It is not necessary to use western anti-inflammatory drugs, or only use them for a short period of time, so as to reduce or avoid the side effects caused by western drugs. From personal experience, if the effect of Chinese medicine treatment is not significant after a period of time, it is sometimes advisable to combine it with anti-inflammatory drugs for 1-2 weeks, which may achieve better results.
(3) In most cases (from personal experience), the use of surgical treatments such as tympanic membrane puncture, tympanotomy and adenoidal hypertrophy removal can be considered unnecessary, and the same effect of curing otitis media, relieving the symptoms of adenoidal hypertrophy and eliminating the symptoms of rhinorrhea can be obtained.
(4) When Chinese herbal medicine is the main treatment, it is advisable to cooperate with nasal drops and take immunity-enhancing western medicine or proprietary Chinese medicine as appropriate.
V. Consequences of failure to treat otitis media in children
Failure to treat secretory otitis media in children (not treated, or not effectively treated, or the duration of the disease is very long) may cause aggravation of tympanic chamber lesions, mainly causing tympanic membrane invagination and tympanic chamber adhesions, resulting in tinnitus and significant hearing loss (mild or moderate deafness, usually not to the extent of causing severe deafness).