This document discusses serous otitis media (SOM), also known as glue ear. SOM is a chronic accumulation of non-purulent fluid in the middle ear cavity behind an intact eardrum. It most commonly affects young children and can cause conductive hearing loss. The causes include Eustachian tube dysfunction from infections, allergies, or obstructions. Treatment involves medical management with decongestants, antihistamines, or antibiotics. Surgical interventions like myringotomy with ventilation tube insertion may be used to drain fluid and improve hearing if medical therapy fails. Complications can include persistent ear infections, perforation of the eardrum, or retraction pockets in severe cases.

1. SEROUS OTITIS MEDIA
Dr Chandra Bhan
Assistant professor
MRAMC

2. SYNONYMS
Serous Otitis Media
Secretory Otitis Media
Glue Ear
Mucoid otitis media
otitis media with effusion
Exudative otitis media
Tubotympanic catarrh

3. DEFINITION
 Chronic accumulation of non purulent serous or
mucoid fluid within middle ear cleft.
 Time that fluid has to be present for the condition to be
chronic is usually taken as 12 weeks.
 Mostly affects children
 Insidious onset
 Sterile in nature.
 Behind an intact and retracted TM.
 With conductive hearing loss

4.  50% of all children- before the first birthday, 80% of all
children - before the third birthday – have OME
 Prevalence bimodal at 2 & 5 yrs when child first
attends play group school & when goes to primary
school
 More during winters
 Each episode of ASOM increases odd ratio of
developing OME by 12
 M > F

5. AETIOLOGY
ET Malfunctioning.
 Obstruction
 Adenoid hyperplasia
 Tumours (nasopharyngeal carcinoma)
 Palatal defects
 Palatal paralysis
 Hyperbaric oxygen therapy
 Oedema during radiation therapy
 Spread of Infection
 Chronic adenoiditis
 Chronic rhino-sinusitis
 Chronic tonsillitis
 High prevalence in HIV patients

6. Increased Secretions
 Allergy
 Milk
 Cigarette smoke (specially mother smoking)
 Obstruct the ET by oedema and increases the secretion
as mucosa act as shock organ in such cases.
 Infections
 Unresolved AOM
 Viral Infections

7. PATHOGENESIS
 Eustachian tube dysfunction
 Failure of aeration
 Failure of drainage
 Increased secretion in ME
 Due to Increase in secretory glands
 Spontaneous resolution if
 Drainage via ET restablished
 Perforation of the tympanic membrane ocure
 If both continue  OME

8. CLINICAL FEATURES
 Hearing loss- up to 40 db
 Mild otalgia
 Ear fullness
 Tinnitus
 Children
 Delayed Speech and defective speech
 PoorAcademics
SYMPTOMS

9. Clinical Features: Signs
 Conductive hearing Loss - TFT
 Otoscopy
-Signs of TM retraction.
-Loss of light reflex
-Colour – Yellow/Grey/ Blue
-Thin blood vessel along handle of malleus ant periphery of tm
 Signs of Effusion
Air Bubbles
Fluid Levels

10.  Pneumatic Otoscopy
 Used to assess the mobility and position of TM
 Observe TM movement by
Increasing Pressure in EAM – Siegel’s speculum
Increasing pressure in ME - Valsalva namoeuver
 TM may be Mobile/ Partially Mobile/ Immobile

11. Evaluation
 TFT-
Rinne - negative
Weber- lateralized towards more diseased ear.
ABC –normal both ear
 Audiometry
 Pure ToneAudiometry
Bilateral Conductive Hearng Loss
20 – 40dB
Sometimes SNHL due to fluid pressing round window

12.  Tympanometry (sensitivity 96 %)
 Assess compliance of TM
 Mobility of TM on increase/ decrease of pressure in EAM
 Graphic representation
 4 patterns
A/As/Ad/B/C
 In OME – B & C
 Reduced compliance with flat curve with a shift to
negative side.

13. Tympanogram
2012

14.  Radiology
Xray Skull Lateral view
Adenoid Hyperplasia
 Xray Mastoid Schuller’s View
Clouding of air cell
 MRI
 Absence of fluid does not imply an absence of OME, as
one-third of patients in MRI study had fluid in mastoid, but
not in the mesotympanum (Kew et al)
 Nasal and nasopharyngeal examination.

15. TREATMENT
 Medical Treatment
 Nasal decongestants
Systemic
 Triaminic Syr 5-10 ml 8 hrly
• Phenylpropanolamine 12.5 mg/5ml
• Chlorpheniramine 2 mg/5ml
 Pseudoephedrine 25 mg
Local
 Nasivion – Oxymetazoline 0.05% drops.
 Otrivin – Xylometazoline 0.1% drops.

16.  Anti-allergy measures
 Antihistamines
 Nasal Steroids spray
 Surface tension lowering agent
 N acetyl cyteine 30 mg tds X 15 days beneficial
 Antibiotics (no long term benefit, can be used for initial 2 wks)
 Middle Ear Aeration
 Valsalva Maneuver

17.  Surgical Treatment
 Myringotomy
 Myringotomy with ventillation tubes (improves hearing by 12
dB)
 Adenoidectomy (improves hearing by 8 dB)
 Tonsillectomy
 Cortical Matoidectomy (in failure of ventilation tube cases)

18. Ventilation tubes
 Also known as grommet
 Inserted through radial incision in AS or AI quadrant of
TM.
 Longer a tube stays in situ longer it can be potentially
benefit
 On other hand, longer a tube is in situ the greater the
chance of complications like-
 Infection
 Granulation tissue
 Permanent perforation
 Thinning of TM with possible retraction

19. TYPES
 Shepard Armstrong
 Reuter Bobbin
 Goodie t tube
 Silicone T tube
 Shah tube
FUNCTION
 Ventilate the middle ear
 Drain the middle ear
 Improve the hearing
 Epithelium will revert back to normal

20. Complications of ventilation tubes
 Intra op


Displacement into middle ear
Damage to ossicles
 Early post op




Blockage
Granulation around tube
Ear infection
Otorrhoea
 Late post op



Permanent perforation
Tympanosclerosis
TM atrophy & retraction

21. SEQUELAE OF OME
 Adhesive Otitis Media / TM atelectasis
 TM atrophy  Retraction Pockests Cholesteatoma
 Ossicular Necrosis
 Tympanosclerosis
 Cholesterol grannuloma