Secretory otitis media (SOM) is defined as an accumulation of fluid in the middle ear cavity that is not associated with signs and symptoms of acute otitis media. The fluid in the middle ear forms a barrier between the eardrum and sound transmission. The incidence is higher in children. Key points in the diagnosis of secretory otitis media include an intact middle ear effusion behind the tympanic membrane, no history of acute attacks, and no accompanying signs and/or symptoms of acute otitis media. I. Clinical manifestations The clinical manifestations of secretory otitis media are mainly hearing loss, which can vary with body position, mild ear pain, tinnitus, a sense of ear occlusion, and the sound of water can be heard by shaking the head. The tympanic membrane is poorly marked, amber or darkened, with visible air-fluid flats or bubbles, reduced tympanic membrane mobility, and in severe cases, extreme inversion of the tympanic membrane, which is connected to the tympanic capsule except for the peripheral portion. In infants and young children, they show poor response to surrounding sounds, ear scratching, easy to wake up from sleep, and easy to be irritated. Diagnostic methods Currently, the following diagnostic methods are used clinically: tympanic otoscopy, tympanic chamber conductivity and acoustic reflex, microscopic endoscopy, tympanocentesis or tympanotomy, and ultrasound diagnosis. Tympanic otoscopy and tympanotomy are considered to be the gold standard for the diagnosis of secretory otitis media. 1. Tympanic otoscopy Otoscopy is often the first test performed in patients with ear complaints, and it is convenient and easy to perform. Changing the air pressure in the external ear canal allows observation of the activity of the tympanic membrane. Tympanic otoscopy is still the best method to diagnose secretory otitis media. 2. Tympanic chamber conductivity map Acoustic conductivity testing is a quick and effective way to test the function of the middle ear. It is generally accepted that if the tympanic chamber conductance map is type B, the diagnosis of secretory otitis media can be made in combination with clinical findings. This method is mainly a confirmatory diagnosis. After surface anesthesia of the tympanic membrane, the tympanic membrane is incised or punctured under the ear microscope, depending on the size of the tympanic membrane, and the presence of secretory otitis media can be confirmed if plasma-like or mucus-like fluid flows out. However, this is an invasive test that is not easily accepted by patients and is not widely used as a diagnostic tool in clinical practice. 4. Ultrasound diagnosis In fact, this diagnosis is not used much in clinical practice. Treatment of SOM At present, there are mainly the following views on the treatment: observation and expectation therapy; drug therapy; surgical treatment. Whether SOM can heal itself depends on the cause of the disease and the time of fluid accumulation. 2.Drug treatment The common clinical treatment methods at present include drug administration after tympanic membrane puncture, drug injection after tympanic chamber fluid extraction, laser treatment, etc. The drugs used clinically to treat secretory otitis media include antibiotics, decongestants, antihistamines and steroids. Dongling keratase for secretory otitis media, chloromethasone solution for middle ear irrigation, BCG vaccine. (1) Steroids, antibiotics and antihistamines, etc. (2) Mucosolvan, Genoton, Cernod, Fodorostim (3) Topical chlorodi ear drops (4) Topical hydroxymetazoline hydrochloride (or ephedrine), beclomethasone dipropionate aerosol 3. Surgical treatment Indications for surgery are SOM lasting more than 4 months with hearing loss and other symptoms; persistent or recurrent SOM; with the presence of high-risk factors ( As long as the child is at high risk, surgery should be performed as soon as possible regardless of the duration of fluid accumulation); and damage to the tympanic membrane or middle ear structures. Compared to tympanic puncture, tympanic tube placement is the first choice for surgical treatment. Compared to tympanic puncture, tympanic tube placement maintains long-term air pressure balance, reduces cupping and glandular hyperplasia, prevents excessive fluid production, and indirectly promotes recovery of cilia movement, allowing time for improvement of eustachian tube function. Tympanic membrane puncture is also useful in the treatment of secretory otitis media, but the puncture hole is not retained for long. (1) Eustachian tube blowing method or blowing by pinching and nasal puffing (2) Tympanic membrane puncture or tympanotomy (3) Tympanic tube placement (4) Treatment extended by tympanic membrane puncture and tube placement 1) Tympanic membrane puncture plus ultrasonic nebulization 2) Oxygen administration in the tympanic chamber 3) Intra-drum injection of hydrogen peroxide for secretory otitis media 4) Tympanic chamber puncture and aspiration + negative pressure suction + positive pressure tympanic chamber injection of α-chymotrypsin, dexamethasone solution, epinephrine method (5) Nd:YAG laser treatment (6) Surgery Treatment A. Removal of local lesions or causes, including adenoidectomy, tonsillectomy and nasal surgery. B. For patients with SOM who are not treated by multiple methods and have recurrent attacks that last for several years, mastoidectomy can be considered.