Otitis Media (Secretory)
(Serous Otitis Media; Otitis Media with Effusion)
Secretory otitis media occurs when acute otitis media has not completely resolved or allergies cause blockage of the eustachian tube.
People may have fullness and some temporary hearing loss in the affected ear.
Doctors examine the ear and use tympanometry to diagnose this disorder.
Doctors may need to make an opening in the eardrum to let fluid drain.
Secretory (serous) otitis media can develop from acute otitis media that has not completely cleared or from a blocked eustachian tube (which connects the middle ear and the back of the nose). Allergies and enlarged adenoids are common causes of eustachian tube blockage. Tumors are rare causes of blockage. Secretory otitis media can occur at any age but is particularly common among children (see Secretory Otitis Media in Children) and may persist for weeks to months.
Normally, pressure in the middle ear is equalized 3 or 4 times a minute as the eustachian tube opens during swallowing. If the eustachian tube is blocked, pressure in the middle ear tends to decrease as oxygen is absorbed into the bloodstream from the middle ear. As the pressure decreases, fluid accumulates in the middle ear, reducing the eardrum’s ability to move.
Usually, although not always, the fluid in the middle ear contains some bacteria, but symptoms of an active infection (such as redness, pain, and pus) are rare. People usually notice a fullness in the affected ear and may hear a popping or crackling sound when they swallow. Some hearing loss commonly develops.
A doctor examines the ear to make the diagnosis. Tympanometry helps determine whether fluid is in the middle ear. Doctors examine the nasal passages and upper throat in adults and adolescents to check for tumors.
Most people with secretory otitis media get better without treatment. Decongestants, such as phenylephrine and pseudoephedrine, can be taken by older children and adults according to the doctor's recommendations to reduce nasal congestion but do not help the secretory otitis media. Decongestants should be avoided in younger children, particularly those less than 2 years. People with congestion caused by allergies may be given antihistamines by mouth and/or a corticosteroid nasal spray. Antibiotics are not helpful. Low pressure in the middle ear can be temporarily increased by forcing air past the blockage in the eustachian tube. To do this, the person breathes out with the mouth closed and the nostrils pinched shut (called the Valsalva maneuver). Or the doctor can use a special syringe (middle ear inflator) to blow air into one of the person’s nostrils while blocking the other nostril as the person swallows. This technique (called politzerization) forces the air into the eustachian tube and middle ear.
If symptoms become chronic (lasting more than 1 to 3 months), a doctor may perform a myringotomy, in which an opening is made through the eardrum to allow fluid to drain from the middle ear. A tiny drainage tube (tympanostomy tube—see figure Myringotomy) can be inserted into the opening in the eardrum to help fluid drain and allow air to enter the middle ear. Children may also need to have their adenoids removed (adenoidectomy). To ensure normal language development, young children with prolonged hearing loss from longstanding secretory otitis media may require appropriate treatment.
Myringotomy: Treating Secretory Otitis Media
People with allergies should try to remove known allergens from their environment. Doctors may recommend people undergo treatment that stimulates the body's immune system against allergens (immunotherapy).
People with secretory otitis media should avoid or delay scuba diving and air travel, because changes in environmental pressure can cause ear pain and injury (barotrauma). If air travel cannot be avoided, chewing food or drinking (for example, from a bottle) may help in young children. In older children and adults, often the pressure in the middle ear can be equalized and the discomfort can be relieved by several maneuvers. If outside pressure is decreasing, as in a plane ascending, the person should try breathing with the mouth open, yawning, chewing gum, or swallowing. If outside pressure is increasing, as in a plane descending or a diver going deeper underwater, the person should pinch the nose shut, hold the mouth closed, and try to blow gently out through the nose. This will force air through the blocked eustachian tube.