Secretory otitis media (SOM), also known as otitis media with effusion or "glue ear", is a collection of fluid in the middle ear caused by dysfunctional Eustachian tubes. It is most common in children under 5 years old. Causes include upper respiratory infections, enlarged adenoids blocking the Eustachian tubes, and congenital defects like cleft palate. Left untreated, the fluid can lead to conductive hearing loss, ear pain, speech delays in children, and long term complications like thinning of the eardrum. Diagnosis involves tests showing fluid and reduced mobility of the eardrum. Treatment options include antibiotics, decongestants, tube insertion in the e

1. SECRETORY OTITIS MEDIA
(Otitis Media with Effusion)
EFUNNUGA HENRIETTA A.
GROUP 403, 4TH COURSE.

2. INTRODUCTION
Otitis media with effusion (OME), also called serous or
secretory otitis media (SOM) or glue ear, is simply a
collection of fluid that occurs within the middle ear space
due to the negative pressure produced by altered
Eustachian tube function. It is more common in children
than adults (about 85% of cases are found in children).

3. ETIOLOGY
In children:
 Upper respiratory infections.
 Congenital factors e.g. cleft palate, cleft lip.
 Eustachian tube dysfunction due to adenoids enlargement.
In adults
 Allergies.
 It can also precede acute otitis media.
 Barotraumas.
 Nasopharyngeal tumors.
 Rhinosinusitis.

4. PREDISPOSING FACTORS
 Early-onset OME is associated with feeding while lying
down and early entry into group child care,
parental smoking, too short a period of breastfeeding.
 Other factors include: prolonged nasotracheal intubation,
head and neck surgeries like maxillectomy,
 Radiotherapy of the head and neck and
immunodeficiency disorders like multiple myeloma,
 Cystic fibrosis and HIV/AIDS.

6. CLINICAL FEATURES
Clinical features include conductive hearing loss;
sometimes due to increased pressure, otalgia and speech
difficulties if it occurs very early in children.

7. COMPLICATIONS
Acute SOM resulting from recurrent upper respiratory
infections and allergy usually resolves spontaneously after
few days of onset without complications. However, if OME
fails to resolve within 6 weeks, it becomes chronic. As a
result, atrophic tympanic membrane can result from
thinning and degeneration of the fibrous layer of the TM
giving rise to atelectasis of the middle ear and retraction of
the tympanic membrane. Other complications include
tympanosclerosis and ossicular bones necrosis.

8. MANAGEMENT
 Pure Tone Audiogram (subjective test) establishes
conductive hearing loss usually ≤40dB.
 Tympanometry establishes a flat type B tympanometry
curve for confirmation.
 Otoscopy shows intact but dull tympanic membrane lacking
in the light reflex with obvious restrictions in mobility. The
appearance may range from brown to yellow.
 The tympanic membrane may show fluid level and/or air
bubbles if the effusion is serous and the TM translucent. It
might appear bulgy.
 On the contrary the TM may exhibit certain degrees of
retractions when there is a scanty viscous fluid within the
middle ear.

9. TREATMENT
CONSERVATIVE INCLUDES:
 Antibiotics.
 Topical analgesics.
 Valsalva maneuvers and physiotherapy.

10. SURGICAL TREATMENT
Surgical treatment is indicated in case of no results from
conservative treatment. The surgical treatment may include
the following:
 Causative factors amenable to surgery might require
specific surgical repairs or maneuvers to resolve the SOM
and prevent future occurrences. Examples are cleft
lip/palate repairs, antrostomy and wash outs,
adenoidectomy/tonsillectomies.
 In situations where the effusion is viscid or massive,
myringotomy is indicated for such evacuations.
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