Secretory otitis media is relatively new to many parents, but when it comes to water in the ear that affects hearing, many parents have encountered it. This is a type of non-suppurative otitis media without pus. The main clinical symptoms are a feeling of stuffiness in the ear, hearing loss, and a change in the perception of sound quality. Since the fluid in the middle ear gradually becomes concentrated and becomes similar to glue, we call it “glue ear”, and the child’s own physiological function is unable to remove the fluid at this time, so surgery is necessary. Therefore, it is important to pay attention to the early stages of the disease. I believe that many doctors know that otitis media is difficult to treat in clinical practice. The reason for this is that the effectiveness of treatment is uncertain, the etiology of the disease is unclear, and it is generally related to the functional state of the eustachian tube. There are a number of theories to explain the cause of the disease, but here we will only talk about two surgically relevant theories: the mechanical obstruction theory and the middle ear microlung theory. Mechanical obstruction is simply an obstruction of the eustachian tube, which causes an obstruction in the drainage of the eustachian tube and the removal of middle ear secretions, leading to middle ear effusion. Among them, obstruction of the pharyngeal opening of the eustachian tube by adenoid hypertrophy is the main cause, which is also the main theoretical basis for surgical removal of adenoids to treat secretory otitis media. However, in clinical practice, we have found that after removal of adenoids, only about 30% of patients can be cured, and about 40% of patients improve, and there are still many patients who are ineffective. This is the reason for the existence of the second surgical modality, middle ear tympanic membrane puncture and tympanic tube placement, for which the middle ear microlung theory is the rationale. Modern research has shown that the middle ear mucosa is a true respiratory mucosa with a gas exchange function. When pathogenic factors lead to mucosal dysfunction, the middle ear becomes impaired in gas exchange, causing negative pressure in the middle ear, which in turn causes congestion and edema in the middle ear mucosa, increasing exudation and fluid accumulation in the middle ear. In this case, tympanic membrane puncture and tympanic chamber flushing are performed, or tympanic tube placement is performed to connect the middle ear to the outside world, maintain isobaric pressure, and restore the function of the middle ear mucosa. Since tympanic membrane puncture or tube placement alone can also lead to recurrence after the tympanic membrane has healed, adenoidectomy and tympanic membrane puncture or tube placement are often performed at the same time to improve the cure rate. The diagnosis of secretory otitis media relies on acoustic conductance testing, pure tone audiometry, and otoacoustic emission testing. In clinical practice, the tympanogram is negative or horizontal. Due to the imperfect development of the eustachian tube in children, a negative pressure above -100 mmH2O is generally appropriate for the negative pressure type, indicating negative pressure in the middle ear. It is currently believed that a negative pressure above -200 mmH2O indicates that the middle ear may be or has been effused; a horizontal tympanogram with a straight line indicates fluid in the middle ear. Pure tone audiometry can be performed in older children, mostly with conductive deafness, low frequency loss, and mild to moderate hearing loss, below 60 db, but with a large change in sound perception. Otoacoustic emissions are not mandatory to be examined, and are usually not triggered when the hearing threshold is greater than 30 db or more. Treatment of secretory otitis media is clinically tricky. What is the degree of conservative treatment and surgical treatment? It is a problem that clinicians struggle with. Surgery is the easiest thing for the surgeon to do, but excessive surgical treatment is also a great burden for the child. In the experience of clinical work, it is found that many patients with horizontal or negative pressure type of tympanogram still have normal hearing after repeated examinations, the reason of which may be due to the imperfect development of pharyngeal canal in children. Therefore, the timing of surgery should be selected for patients whose hearing loss has already occurred and whose conservative treatment has been ineffective for 3-6 months, and whose tympanogram has not improved. Drug treatment is mandatory in the early stage of secretory otitis media. In the acute stage, antibiotics, glucocorticoids and decongestants should be used as early as possible for a short period of time as nasal spray; in the chronic stage mucus promoters must be used for a long period of time, while treatment of rhinosinusitis, pharyngitis, tonsillitis, adenoids and other related diseases should be actively treated. Regular acoustic impedance examinations should be performed. If the hearing (and also the tympanogram) returns to normal or recurs during the treatment period, it means that the secretory otitis media is still in a reversible stage and surgery can be suspended. However, if the treatment is active and standardized for 3-6 months, there is no effect of surgical treatment. The main surgical treatments are adenoidectomy, tympanic membrane puncture and irrigation, and tympanic tube placement. Adenoidectomy can relieve the obstruction of the pharyngeal orifice of the eustachian tube, and if snoring is combined, it should be removed surgically; tympanic membrane puncture and tube placement can relieve the negative pressure of the middle ear and maintain the normal function of the middle ear mucosa. The choice between tympanocentesis and tympanic tube placement is also an issue. Tympanocentesis is less damaging and quicker to recover, but the effect is not as certain as tympanic tube placement. The efficacy of tympanic tube placement is certain, but the tube needs to be left in place for more than 6 months and is prone to side effects such as middle ear infection, detachment, and tube removal. Recent studies have shown that patients with tympanic tubes also have a slightly higher incidence of distant cholesteatoma than patients without tubes (or in the opposite ear). The choice of surgical procedure is the result of a comprehensive consideration by the physician and a choice that needs to be made after communication with the parents. Factors that influence secretory otitis media in children are: 1. Recurrent upper respiratory infections trigger catarrhal otitis media, acute rhinitis, acute pharyngitis, acute tonsillitis and adenoids, causing negative pressure and fluid accumulation in the middle ear. So reducing colds may be a good way to prevent the disease. 2. Incorrect habits, such as excessive forceful nose blowing and aspiration, affect the middle ear. 3. Chronic sinusitis, chronic pharyngitis, and chronic adenoids, which are not treated in time, cause secretory otitis media for a long time.