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Abstract: The patient, a 50-year-old male, presented with symptoms of stuffiness in both ears, hearing loss, and intermittent running tinnitus one month ago. Examination revealed the presence of conductive deafness and tympanic chamber effusion without symptoms of ear discharge, and the final diagnosis was secretory otitis media. Most cases of secretory otitis media are caused by Streptococcus pneumoniae infection. The patient was given surgical treatment, and the patient recovered hearing in both ears, with good wound healing and no further symptoms of tinnitus like running water in the ear.
Basic information】Male, 50 years old
Disease Type】Ear leakage (secretory otitis media)
Hospital】Beijing Tongren Hospital, Capital Medical University
Date of Consultation】April 2022
Treatment plan】Surgical treatment (tympanotomy and drainage) + external drug flushing treatment (dexamethasone sodium phosphate injection) + injectable drug treatment (ceftizoxime sodium for injection)
Treatment period】Hospitalization for 3 days, regular review
Treatment effect] The patient’s hearing was restored in both ears, the wound healed well, and no more tinnitus like water in the ear occurred.
I. Initial consultation
The patient, a 50-year-old male, came to the clinic with a painful expression and said he had hearing loss in his ears and needed to speak loudly to be heard. He reported that he had experienced blockage in both ears, hearing loss, and intermittent tinnitus with running water about a month ago, and that his treatment with antibiotics was not effective. When asked about his past medical history, he said he was physically fit and had no history of tumor, trauma, exposure to risk factors or infectious diseases. The patient was examined and showed hearing loss in both ears with tinnitus. When pressure was applied to both ear screens, the patient’s ear blockage symptoms were reduced. In order to further clarify the cause of the disease, the patient was given a complete examination.
The otoscopic examination showed that the tympanic membrane was invaginated and fluid was present in both ears with limited tympanic membrane activity. The patient was given a CT scan of the temporal bone, which showed increased density in the middle ear cavity bilaterally, suggesting a tympanic effusion. The above findings and the patient’s past medical history led to the diagnosis of secretory otitis media.
II. Treatment history
Because of the severity of the patient’s secretory otitis media, an endoscopic tympanotomy was required to observe the specific situation. After the patient was treated with local anesthesia, the tympanotomy was successfully performed. The patient was observed under the otoscope and a yellowish fluid was seen in the tympanic chambers of both ears. Postoperative bacterial culture of the secretion was performed and showed Streptococcus pneumoniae.
Three days later, the patient reported that the feeling of occlusion in both ears had improved and there was no tinnitus or pain, and there was an incision in the lower anterior limit of the tympanic membrane on otoscopic examination.
III. Treatment effect
The patient underwent the surgery smoothly and did not have any discomfort such as vertigo, and returned to the ward safely after the surgery. On the second postoperative day, the patient’s bilateral occlusion gradually improved and his hearing gradually recovered. On the third postoperative day, the patient’s symptoms of occlusion in both ears improved significantly, and the tinnitus symptoms disappeared completely. At 1 week after surgery, the patient’s hearing had been restored in both ears, the wounds were healing well, and no more tinnitus symptoms like running water appeared in both ears. Subsequent reexaminations at 2 and 4 weeks after surgery did not show any abnormalities either.
IV. Notes
I was very happy to see that the patient’s condition was significantly relieved, but the patient was not completely cured when he was discharged from the hospital, and secretory otitis media may recur, so the patient still needs to take the following precautions.
1. Patients need to ensure that the external ear canal area is clean and dry on a daily basis and avoid contact with water or digging the ear with greater force to avoid affecting wound healing. In case of accidental water ingress, disinfection treatment needs to be given promptly and observed for any abnormalities.
2. Patients also need to avoid forceful nose blowing after discharge to avoid aggravating the symptoms of ear blockage.
3. In daily life, it is necessary to ensure a quiet environment and avoid too much noise to avoid aggravating the symptoms of hearing loss.
4. Patients who have recovered well can choose to do appropriate physical activities, such as running, which can enhance the body’s ability to resist diseases.
V. Personal insight
For patients with secretory otitis media, they can choose to give conservative treatment or surgical treatment, but like the patient in this case, if they do not take antibiotic medication on their own, they need to take timely surgical treatment to remove the middle ear fluid, and at the same time give corresponding antibiotic medication according to the specific pathogen, which can control the infection. If a patient has symptoms such as hearing loss or ear blockage, it is recommended that he or she actively visit a hospital and be given the appropriate tests to clarify the cause and then give timely treatment to avoid delaying the disease.