Secretory otitis media

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Secretory otitis media
Shankai Yin Prof Dept of Otolaryngology, the
sixth hospital affiliated to Shanghai jiaotong
university Otolaryngology institute at Shanghai
jiaotong university
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Denomination

• Otitis media with effusion
• Exudative otitis media
• Mucoid otitis media
• Catarrhal otitis media
• Tubotympanitis
• Non-suppurative otitis media
• Secretory otitis media

1991 ?????????????
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Pathology

• Middle ear effusion
• Serofluid? Mucus?Sero-mucous,non blood or CSF
• Epithelium mucosae thicken,Epithelial metaplasia
• Pseudostratified columnar ciliated epithelium
  Secretory epithelium

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Epidemiology

• Main in children
• 5.2-21.6( by aural speculum,Hongkong),7.3-30.7(b
  y 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

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Etiology

• Eustachian tube dysfunction
• Eustachian tube blockage
• Ciliary dysfunction
• Infection
• Immune reaction

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Eustachian tube dysfunction

• Disease in pharynx nasalis
• Adenoidal hypertrophy
• Nasopharyngeal carcinoma
• Tumour from parapharyngeal space

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Eustachian tube dysfunction

• Circumflexus palati?levator palati weak
  
  
• Cartilage of eustachian tube problem
  

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Eustachian tube dysfunction

• Rhinosinusitis
• Nasal polypus

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Infection

• Germ in excretion of mid 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

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Immune reaction

• Type I
• Allergic rhinitis
• Nasal polyp
• Bronchial asthma
• Type III
• Bacterium in adenoid and pharynx oralis

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Clinical manifestation

• Common cold
• Hearing disturbance
• Earache
• Fural fullness
• Tinnitus

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Objective sign

• Deaphragma auris
• Hyperemia
• Invagination
• Mobility diminished
• Cavum tympani
• Fluidify
• Air bubble
  

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Objective sign

• Pure tone test
• Conductive hearing loss

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Objective sign

• Combined deafness deafness
• Bacterium or toxin reach inner ear by RWM
• HC hurt

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Objective sign

• Acoustic impedance
• Type Btypical plot
• Type Ceustachian tube dysfunction

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Differential diagnosis

• Nasopharyngeal carcinoma
• Single secretory otitis media,adult,lump in
  neck,epistaxis
• Epipharyngoscope,CT,MRI
• Cerebrospinal otorrhea
• Trauma or congenital deafness
• Temporal bone CT

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Differential diagnosis

• Perilymphorrhea
• Stapes operation,sudden deafness
• Tullio phenomenon
• Cholesterol granuloma
• Sequela of secretory otitis media
• Dark blue eardrum
• Temporal bone CT

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Treatment

• Spontaneous cure
• Etilogical treatment
• Adenoidectomy
• Amygdalectomy
• FESS
• Explorative tympanotomy

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Treatment

• Drug treatment
• Antibiotic
• Glucocorticosteroid
• Decongestant
• Ambroxol

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Treatment

• Eustachian tube inflation

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Treatment

• Paracentesis tympani

Both diagnosis and treatment
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Treatment

• Paracentesis tympani
• Surface anesthesia
• Only adult
• Asepsis
• Complication
• infection,
• impairment of RWM
• auditory ossicle
• fenestration oval window

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Treatment

• Myringotomy
• Cutter knife
• Carbon
• Dioxide laser

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Treatment

• Grommet insertion

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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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• Thank you