Secretory Otitis Media

(Serous Otitis Media)

Secretory otitis media is an effusion in the middle ear resulting from obstruction of the eustachian tube with or without infection. Symptoms include hearing loss and a sense of fullness or pressure in the ear. Diagnosis is based on appearance of the tympanic membrane and sometimes on tympanometry. Treatment may include antihistamines and topical corticosteroids if allergies are present; persistent cases may require a trial of systemic antibiotics, decongestants, and myringotomy.

Geriatric Essentials

• Unilateral secretory otitis media in elderly patients may require evaluation for a nasopharyngeal mass, which can obstruct the nasopharyngeal orifice of the eustachian tube.

Secretory otitis media in the elderly commonly results from obstruction of the eustachian tube occurring with a viral or bacterial URI. Obstruction can occur without evidence of infection. If unilateral, the disorder may be caused by a nasopharyngeal mass.

Symptoms and Signs

Symptoms include a sensation of aural fullness and hearing loss without pain. Otoscopic examination detects amber fluid filling the middle ear, causing the malleus handle to appear whiter than usual. An air-fluid level or air bubbles seen through the tympanic membrane after autoinflation of the ear (by blowing the nose), usually accompanied by a bubbling or squealing sound and transient improvement in hearing, suggests improving eustachian tube function and may herald resolution of the effusion. Pneumotoscopy detects sluggish or no movement of the tympanic membrane. Conductive hearing loss is present.

Diagnosis

Persistent unilateral secretory otitis media in elderly patients requires evaluation for a nasopharyngeal mass, which can obstruct the nasopharyngeal orifice of the eustachian tube. This orifice should be examined with a mirror or fiberscope. If this examination is normal, CT or MRI is indicated to look for a more lateral obstruction. Imaging may also detect a dehiscence of the bone between the brain and ear, which can allow the ear to fill with CSF. The neck must be examined for lymphadenopathy.

Treatment

For most patients, watchful waiting is all that is needed. For patients who have allergies, antihistamines and intranasal corticosteroids may be helpful. Nasal decongestant sprays have no proven value; if used, they should be stopped after a maximum of 3 days. Routine use of antibiotics has no proven value. However, antibiotics should be given to patients with bacterial rhinitis, sinusitis, or nasopharyngitis. If a nasopharyngeal mass has been excluded, patients with conductive hearing loss and middle ear fluid persisting for > 1 mo may require myringotomy with aspiration of fluid and possibly insertion of a ventilation tube. Typically, a simple secretory effusion will stop draining shortly after a myringotomy tube is placed. If fluid continues to pulse from the myringotomy tube, a CSF leak should be ruled out.

If a nasopharyngeal mass is identified, treatment depends on the type and extent of the mass.

This topic was last updated June 2006.