Secretory otitis media (serous otitis media) is fluid accumulation behind the eardrum (see Middle and Inner Ear Disorders: Otitis Media (Secretory)).

• A previous ear infection is the usual cause, although some children may develop it as a result of gastroesophageal reflux disease or a blocked eustachian tube.
• Children have no pain, but fluid can impair hearing.
• Diagnosis involves physical examination of the eardrum and sometimes tympanometry.
• Secretory otitis media usually resolves on its own, although some children need surgery to install a ventilating tube.

Secretory otitis media often occurs after acute otitis media. The fluid that has accumulated behind the eardrum during the acute infection remains after the infection resolves. Secretory otitis media may also occur without a preceding ear infection. It may be due to gastroesophageal reflux disease or a blockage of the eustachian tube by infection or enlarged adenoids. Allergies may also make secretory otitis media more likely to develop. Secretory otitis media is extremely common among children aged 3 months to 3 years.

Although this disorder is painless, the fluid often impairs hearing. Hearing may be impaired sufficiently to affect the understanding of speech, language development, learning, and behavior.

Did You Know... After an ear infection, fluid may accumulate behind the eardrum, interfering with hearing but causing no pain.

Diagnosis

Doctors diagnose secretory otitis media by looking for changes in the color and appearance of the eardrum and by squeezing air into the ear to see if the eardrum moves. If the eardrum does not move but there is no redness or bulging and the child has few symptoms, secretory otitis media is likely. If findings on the examination are unclear, doctors often do tympanometry. In tympanometry, a device containing a microphone and a sound source is placed snugly in the ear canal, and sound waves are bounced off the eardrum as the device varies the pressure in the ear canal.

Treatment

Secretory otitis media often does not resolve when treated with antibiotics or other drugs, such as decongestants, antihistamines, or nasal sprays. But it often resolves by itself after weeks or months.

If the disorder persists and children do not improve after 3 months, surgery may help. In the United States, myringotomy may be done. For this procedure, doctors make a tiny slit in the eardrum, remove the fluid, and insert a small ventilating (tympanostomy) tube in the slit to provide drainage from the middle to the outer ear. The adenoids (collections of lymphoid tissue located where the throat and nasal passage meet) are often removed at the same time. Sometimes a myringotomy is done to remove fluid but not to insert ventilating tubes. This procedure is called tympanocentesis.

Last full review/revision January 2009 by Robert J. Ruben, MD