Serous otitis media

Definition, symptoms and causes

Glue-ear, serous otitis media is the most common in children

Glue-ear is serous otitis media and the youngest are the main ones to be affected.

Glue ear and serous otitis media causes

Serous otitis media, also known as catarrhal otitis, tubal otitis and effusive otitis, is distinguished according to the type of exudate present in the middle ear for: serous, serum-mucous and mucoid otitis. In chronic forms, the exudate can become particularly dense, similar to glue, hence the name of "glue-ear". This form of otitis is the most common cause of impaired hearing in children, with a small percentage of cases in adults. Several factors contribute to the onset of effusive otitis media such as:

  • subjective factors: age, immune status, prematurity
  • local factors: particular shape of the middle ear, adenoid hypertrophy, structure of the Eustachian tube, cleft palate and craniofacial anomalies
  • trauma or alteration of the pressure values of the middle ear
  • seasonality: the incidence of effusive otitis media is higher in the winter months
  • other factors: passive smoking and use of pacifiers 
  • subjective factors: age, immune status, prematurity

Although otitis media can occur at any age, it is much more common in the pediatric age group, in fact, in the winter season, about 30% of children who attend kindergarten suffer from effusive otitis which lasts for several months. In children, adenoid hypertrophy hinders the normal functioning of the Eustachian tube causing an increase in the secretion of the eardrum and accumulation of transudate that partially or totally occupies the eardrum.

The symptoms of effusive otitis are characterized by reduced hearing, autophony, a feeling of full ear and tinnitus. The exudate, if extremely abundant, can cause pain and perforation of the eardrum membrane. The perforation causes the disappearance of pain and the drainage of exudative material from the ear. Fever is absent and exacerbations are frequent.                                                              

Remedies for the serous otitis media

The specialist visit assumes primary importance to prevent relapses and the risk of permanent hearing damage.

  • Medical therapy consists of the use of corticosteroids, nasal washes, and crenotherapy (thermal water). This last remedy is primarily indicated by restoring tubal permeability and trophism of the mucous membrane of the tympanic cavity.
  • Surgical therapy provides the removal of any adenoid vegetations (adenoidectomy) and, in the case of a closed eardrum, the apposition of the transtympanic drainage.

In this case, a small polyethylene tube is inserted into the eardrum membrane so as to allow the flow of exudate from the middle ear outwards and ventilation of the eardrum case.

The use of transtympanic drainage, which has always been subject of controversy, is to be used when there has been no benefit in the three to six months following the start of medical therapy. In fact, failure to benefit from medical therapy can lead to irreversible lesions of the mucous membrane of the eardrum case and of the eardrum itself, with consequent irreversible conductive hearing loss. The application of drainage allows immediate recovery of hearing loss, but does not seem to improve the natural history of effusive otitis in the long term. The expulsion of the drainage occurs spontaneously, within three months of application, or is removed by the surgeon as soon as the resolution of the effusion is complete, in order to avoid the onset of tympanosclerosis.

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