secretory otitis media. denomination otitis media with effusion exudative otitis media mucoid otitis...

Secretory otitis media

Denomination

• Otitis media with effusion

• Exudative otitis media

• Mucoid otitis media

• Catarrhal otitis media

• Tubotympanitis

• Non-suppurative otitis media

• Secretory otitis media(分泌性中耳炎 )

Pathology

Middle ear effusion

Serofluid 、 Mucus 、 Sero-mucous ， non

blood or CSF

Epithelium mucosae thicken ， Epithelial

metaplasia

Pseudostratified columnar ciliated epithelium

Secretory epithelium

Epidemiology

• Main in children

– 5.2-21.6% （ by aural speculum ， Hongkong）， 7.3-30.7%

（ by acoustic impedance ， Hongkong ） in 2-7 year-old

– 15-40% （ 2004 ， USA ） in 1-5 year-old

– 3.8% in 2 year-old ， 1.1% in 11 year-old （ Suarez Nieto ， 1983 ，USA）

• More than 50% infant occurs ， most natural cure in 3

months

Etiology

• Eustachian tube dysfunction

– Eustachian tube blockage

– Ciliary dysfunction

• Infection

• Immune reaction

Eustachian tube dysfunction

• Disease in pharynx nasalis– Adenoidal hypertrophy

– Nasopharyngeal carcinoma

• Tumour from parapharyngeal space

Cleft Palate

Cartilage of eustachian

tube problem

Eustachian tube dysfunction

• Rhinosinusitis

• Nasal polypus

Eustachian tube dysfunction

Infection

• Germ in excretion of middle ear （ Senturia ， 1958）• 22-52% positive in excretion of mid ear

• Hemophilies influenzae （ 14.7% ， USA ） and

micrococcus pneumoniae （ 7.0% ， USA ） are the

main pathogenic bacterium

• Also influenzavirus 、 adenovirus 、 chalmdiae

trachomatis

Immune reaction

• Type I

– Allergic rhinitis

– Nasal polyp

– Bronchial asthma

• Type III

– Bacterium in adenoid and pharynx oralis

Clinical manifestation

• Common cold

• Hearing disturbance

• Earache

• Aural fullness

• Tinnitus

Objective sign

• Ear drum

– Hyperemia

– Mobility diminished

• Cavum tympani

– Fluid

– Air bubbles

• Pure tone test

– Conductive hearing loss

Objective sign

Objective sign

Combined deafnessBacterium or toxin reach inner ear by RWMHC hurt

Objective sign

• Acoustic impedance

– Type B ： typical plot

– Type C ： eustachian tube dysfunction

Differential diagnosis

• Nasopharyngeal carcinoma

– Unilateral secretory otitis media ， adult ， lump in neck ，epistaxis

– Epipharyngoscope ， CT ， MRI

• Cerebrospinal otorrhea

– Trauma or congenital deafness

– Temporal bone CT

• Perilymphorrhea

– Stapes operation ， sudden deafness

– Tullio phenomenon

• Cholesterol granuloma

– Sequela of secretory otitis media

– Dark blue eardrum

– Temporal bone CT

Differential diagnosis

Treatment

• Spontaneous cure

• Etilogical treatment

– Adenoidectomy

– Tonsillectomy

– FESS

Treatment

• Drug treatment– Antibiotic

– Glucocorticosteroid

– Decongestant

– Ambroxol

Treatment

• Eustachian tube inflation

Treatment

• Tympanocentesis

Both diagnosis and treatment

Treatment

• Tympanocentesis

– Surface anesthesia

– Only adult

– Asepsis

– Complication

infection，impairment of RWM

auditory ossicle

fenestration oval window

Treatment

• Myringotomy– Cutter knife

– Carbon or Dioxide laser

Treatment

• Grommet insertion

Treatment

• Grommet insertion

– Indication

inefficacy of myringotomy

glue ear

hearing loss ： 40db

Complication

– Tympanosclerosis

– Permanence perforation of ear drum

– Chronic suppurative otitis media

– Sensorineural deafness

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