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Secretory otitis media

Secretory otitis media. Shankai Yin Prof Dept of Otolaryngology, the sixth hospital affiliated to Shanghai jiaotong university Otolaryngology institute at Shanghai jiaotong university. Denomination. Otitis media with effusion Exudative otitis media Mucoid otitis media

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Secretory otitis media

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  1. Secretory otitis media Shankai YinProf Dept of Otolaryngology, the sixth hospital affiliated to Shanghai jiaotong university Otolaryngology institute at Shanghai jiaotong university

  2. Denomination • Otitis media with effusion • Exudative otitis media • Mucoid otitis media • Catarrhal otitis media • Tubotympanitis • Non-suppurative otitis media………… • Secretory otitis media 1991 我国自然科学名词审定委员会

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

  4. 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

  5. Etiology • Eustachian tube dysfunction • Eustachian tube blockage • Ciliary dysfunction • Infection • Immune reaction

  6. Eustachian tube dysfunction • Disease in pharynx nasalis • Adenoidal hypertrophy • Nasopharyngeal carcinoma • Tumour from parapharyngeal space

  7. Eustachian tube dysfunction • Circumflexus palati、levator palati weak • Cartilage of eustachian tube problem

  8. Eustachian tube dysfunction • Rhinosinusitis • Nasal polypus

  9. 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

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

  11. Clinical manifestation • Common cold • Hearing disturbance • Earache • Fural fullness • Tinnitus

  12. Objective sign • Deaphragma auris • Hyperemia • Invagination • Mobility diminished • Cavum tympani • Fluidify • Air bubble

  13. Objective sign • Pure tone test • Conductive hearing loss

  14. Objective sign • Combined deafness deafness • Bacterium or toxin reach inner ear by RWM • HC hurt

  15. Objective sign • Acoustic impedance • Type B：typical plot • Type C：eustachian tube dysfunction

  16. 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

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

  18. Treatment • Spontaneous cure • Etilogical treatment • Adenoidectomy • Amygdalectomy • FESS • Explorative tympanotomy

  19. Treatment • Drug treatment • Antibiotic • Glucocorticosteroid • Decongestant • Ambroxol

  20. Treatment • Eustachian tube inflation

  21. Treatment • Paracentesis tympani Both diagnosis and treatment

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

  23. Treatment • Myringotomy • Cutter knife • Carbon • Dioxide laser

  24. Treatment • Grommet insertion

  25. 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

  26. Thank you

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