Non-Suppurative Otitis Media

Also known as:

• Secretory Otitis Media
• Glue Ear
• Tubotympanic Catarrh
• Exudative Otitis Media
• Otitis Media with Effusion

Definition

Serous otitis media is the presence of non-purulent serous or mucoid effusion in the middle ear cleft.

• Serous effusions result from the collection of "transudates" fluid in the middle ear.
• Mucous otitis media results from active secretion by secretory cells, goblet cells, and epithelial cells.
• Non-suppurative otitis media is common in the cold season.
• It is more prevalent in individuals aged 10 and below.
• Males are more affected than females.

Symptoms

Common symptoms include:

• Deafness: Mild intermittent conductive and fluctuating (changes with position) hearing loss.
• Tinnitus may be present.
• Dull earache.

Otoscopic Examination

During otoscopic examination, you may observe:

• Retracted or immobile dull tympanic membrane.
• Air bubbles or fluid level may be seen behind the tympanic membrane.

Investigation

Important investigations include:

• Pure tone audiometry: Shows conductive hearing loss.
• Tympanometry: Shows Type B patterns.

Treatment

• Treat the primary cause.
• Acute cases respond well to medication.
• Chronic cases require surgery.

Medical Treatment

• Nasal decongestant.
• Antihistamines.
• Steam inhalation.
• Antibiotics: If there is an infection.

Surgical Treatment

• Adenoidectomy.
• Myringotomy.
• Laser-assisted tympanostomy.
• Ventilation tubes (Grommets) insertion: To ventilate the middle ear, improves hearing, and the epithelium will revert back to normal.

• Otitic barotrauma is otitis media due to pressure changes on either side of the eardrum.
• It occurs due to rapid descent while flying or diving.
• The tympanic membrane is pushed inward, and the middle ear mucosa will be congested with transudation of fluid containing blood.
• The patient experiences severe pain and discomfort in the affected ear, along with conductive deafness.

Treatment

• Valsalva maneuver.
• Eustachian catheterization.
• Myringotomy: If fluid is present, and insertion of grommet tube.

• Adhesive otitis media, also called atelectasis, is the collapse of the tympanic membrane towards the tympanic cavity with loss of air space in the middle ear cavity.
• Adhesive OM is an end result of inflammation by the formation of adhesions in the middle ear.

Symptoms

• Conductive hearing loss.
• Tinnitus.
• Retraction pocket with infection.

Treatment

• Prevention is better, treat early.
• Surgery: Tympanoplasty.
• Ventilation tube may help.
• Hearing aid.

• Tympanosclerosis is the deposition of collagen plaques in the middle ear or in the tympanic membrane.
• Myringosclerosis affects only the TM.
• Tympanosclerosis affects the middle ear cleft. It can be open or closed.
• If the TM is perforated, it is open.
• If the TM is intact, it is closed.

Clinical Features

• May be asymptomatic.
• There may be deafness.
• Otoscopy shows chalky white plaques in the membrane.

Treatment

• Surgical removal.
• Use of Hearing aid.

• Tuberculous otitis media is usually secondary to pulmonary tuberculosis.

Special Features

• Multiple perforations of the tympanic membrane.
• Pale granulation.
• Early or more frequent complication.
• Hearing loss is severe.

Complications

• Labyrinthitis.
• TB meningitis.
• Facial nerve paralysis.

Treatment

• Anti-tuberculous treatment.

• Salpingitis is also known as eustachian tube catarrh.
• Acute salpingitis is an acute inflammation of the eustachian tube secondary to acute sinusitis, rhinitis, nasopharyngitis, enlarged adenoids.

Symptoms

• Blocked sensation in the ear.
• Autophony: Patient hears his own voice louder.

Treatment

• Systemic antibiotics.
• Antihistamines.
• Nasal decongestant drops: To reduce congestion of the nose and nasopharyngeal mucosa.
• Steam inhalation with eucalyptus oil.
• Gentle blowing of the nose.
• Adenoidectomy: If there is a recurrent attack.

Etiology

• Trauma: Adenoidectomy scarring and stenosis of the ET opening.
• Chronic infection.
• Chronic rhinosinusitis.
• Chronic allergic rhinosinusitis.
• Chronic adenoid hypertrophy/adenoiditis.
• Chronic lymphoid hyperplasia of the nasopharynx.
• Tumor of the nasopharynx.
• Cleft palate.
• Idiopathic.

Symptoms

• Clicking sound on swallowing or yawning.
• Blocked sensation in the ear.
• Fluctuating conductive hearing loss.
• Intermittent tinnitus.

Examination

• Retraction of the tympanic membrane.
• Reduced TM mobility.
• Air bubble and/or hairline seen: Indicating fluid in the middle ear.
• Pure tone average showed-conductive hearing loss.

Treatment

Medical

• Oral decongestant.
• Antihistamine.
• Antibiotics.

Valsalva exercise.

Surgical

• Myringotomy and grommet ventilation tube insertion.
• Treat the primary cause.

• Middle ear infections commonly present with conductive hearing loss because the middle ear is responsible for the transmission and amplification of sounds, while the inner ear transforms the signal into electrical impulses.
• Therefore, any fluid in the middle ear can impede this function.