Definition

Chronic accumulation of serous/mucus discharge within the middle ear cavity and sometimes the mastoid air cell system.

Etiology/ Risk Factors

•           Recurrent upper respiratory infections including tonsillitis and adenoiditis

•           Recurrent attacks of AOM.

•           Eustachian tube dysfunction.

•           Craniofacial abnormalities: cleft palate, Down or Turner syndrome

•           Parental smoking

Clinical Features

·       Blocking sensation of ears

·       Deafness

·       .Dull ear ache

·       TM: dull lustreless with loss of landmarks

·       Bulging of TM

·       Evidence of fluid in the middle ear may be seen as air bubble

·       Decreased TM mobility on valsalva and seigelisation

·       Decreased school performance

Lab Investigations

•           Tympanometry: Type B graph

•           Pure tone Audiometry: Conductive hearing loss

Radiological

•           X RAY Water's view of PNS to rule out nasal and sinus infection.

•           Lateral view of nasopharynx to rule out hypertrophied adenoids.

Management

•           Prevention of secretory otitis media by regular checkup and treatment of URTL

•           Removal of the possible cause: Adenoidectomy and Tonsillectomy.

A.  Pharmacological

Decongestants

•           Phenyiephreine                   5mg HS

•           Pseudophedrine

Adults                                                60 mg P0 q4-6 hrs

Children                                5-30 mg P0 q4-6 hrs Syrup: 3mg/ml

Oxymetazoline orXylometazoline nasal drops

B.  Surgery

Myringotomy and insertion of ventilation tubes in non responsive cases