Many ENT conditions may leave behind residual effects or trigger secondary pathological conditions. One such condition is otitis media, which is an inflammation of the ear due to infection and often affects pediatric patients. Specifically, otitis media can contribute to the subsequent accumulation of fluid in the middle ear. This accumulation of fluid is known as secretory otitis media. Notably, this condition may appear in some cases without a prior ear infection.
What is secretory otitis media?
Secretory otitis media is an ear condition characterized by the collection of non-purulent, non-infectious fluid in the middle ear, without apparent symptoms of infection. This is the main distinction from acute otitis media, where bacterial or viral infections cause pus accumulation in the ear. Secretory otitis media can occur at any age but is more common in children.
Causes of secretory otitis media
The main cause of secretory otitis media is Eustachian tube dysfunction. The Eustachian tube is a small canal that connects the middle ear to the back of the throat and assists in pressure regulation and fluid drainage from the middle ear. Normally, pressure in the middle ear is relieved during swallowing. Swallowing causes the Eustachian tubes to open, which can occur 3 to 4 times per minute, facilitating ear ventilation and pressure equalization. If a Eustachian tube malfunctions, ear ventilation becomes inadequate, leading to fluid accumulation in the middle ear, a key feature of secretory otitis media.
Various conditions can impact the normal functioning of this tube, causing excess pressure in the middle ear cavity and subsequent fluid buildup. These conditions include upper respiratory infections, allergies, or cleft palate. Additionally, obstructive causes such as adenoid hypertrophy, a cyst or tumor in the nasopharynx, or a nasal polyp can disrupt the proper functioning of the Eustachian tube. Finally, radiation therapy in cancer patients or atmospheric pressure changes due to air travel or diving may cause Eustachian tube dysfunction and, consequently, secretory otitis media.
Symptoms of the condition
The symptoms of secretory otitis media are often mild, particularly in children, which may delay timely diagnosis. The main characteristic of the condition is the presence of fluid in the middle ear without apparent signs of infection (fever, pain, or pus discharge). The most common symptom is hearing loss, as the accumulated fluid affects the normal transmission of sound waves through the middle ear. Hearing loss can range from mild to moderate and may be accompanied by tinnitus or dizziness. Additionally, patients with secretory otitis media often report a sensation of fullness or pressure in the affected ear or ears.
Although not associated with significant health risks, secretory otitis media can be particularly detrimental during childhood. This is because prolonged hearing loss, even mild, can impact speech development in young children. In young children, irritability, inattention, or reduced academic performance may also be observed due to hearing loss caused by the condition.
Diagnosis and treatment of secretory otitis media
Diagnosis of secretory otitis media is primarily based on clinical examination and specialized diagnostic tests. Initially, otoscopy is performed to assess the tympanic membrane and the state of the eardrum. Tympanometry, a non-invasive test that measures the mobility of the eardrum, is the next preferred examination. If the underlying cause of the fluid retention remains unresolved, further testing, such as audiometry, may be necessary to evaluate the hearing loss often associated with the condition.
The treatment of secretory otitis media depends on the duration and severity of the condition, as well as its underlying cause. If the fluid in the middle ear persists for more than two months, tympanostomy is usually recommended to drain the fluid and prevent long-term complications, such as possible adhesions. In some cases, tympanotomy is accompanied by the placement of ventilation tubes that allow drainage and ventilation of the middle ear. Medication such as decongestants, antihistamines, and corticosteroids may also be prescribed, while antibiotics can accelerate healing in certain cases. If the underlying cause is adenoid hypertrophy, an adenoidectomy may be performed. ENT Surgeon in Athens Dr. Olga Papadopoulou addresses secretory otitis media with targeted treatment to prevent complications that could impair hearing and overall patient well-being.