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Key Features

Essentials of Diagnosis

  • Blocked eustachian tube remains for a prolonged period

  • Resultant negative pressure will cause transudation of fluid

General Considerations

  • Especially common in children because their eustachian tubes are narrower and more horizontal in orientation than adults

  • It is less common in adults, in whom it usually occurs

    • After an upper respiratory tract infection

    • With barotrauma

    • With chronic allergic rhinitis

  • In an adult with persistent unilateral serous otitis media, nasopharyngeal carcinoma must be excluded

Clinical Findings

  • Tympanic membrane is dull and hypomobile

  • Occasionally accompanied by air bubbles in the middle ear and conductive hearing loss


  • Clinical diagnosis



  • Short course oral corticosteroids (eg, prednisone, 40 mg daily orally for 7 days)

  • Oral antibiotics (eg, amoxicillin, 250 mg three times daily for 7 days)

  • Combination of oral corticosteroids and antibiotics

  • The role of these regimens remains controversial, but they are probably of little lasting benefit


  • When medication fails to bring relief after several months, a ventilating tube placed through the tympanic membrane may restore hearing and alleviate the sense of aural fullness

Therapeutic Procedures

  • Similar to that for eustachian tube dysfunction




  • The patient should be advised to swallow, yawn, and autoinflate frequently during descent, which may be painful if the eustachian tube collapses

  • Oral decongestants (eg, pseudoephedrine, 60–120 mg) should be taken several hours before anticipated arrival time so that they will be maximally effective during descent

  • Topical decongestants such as 1% phenylephrine nasal spray should be administered 1 h before arrival

  • Repeated episodes of barotrauma in persons who must fly frequently can be alleviated by insertion of ventilating tubes


  • Problem occurs most commonly during the descent phase, when pain develops within the first 15 feet if inflation of the middle ear via the eustachian tube has not occurred

  • Divers must descend slowly and equilibrate in stages to avoid major negative pressures on the tympanum, which may result in hemorrhage (hemotympanum) or perilymphatic fistulization, in which the oval or round window ruptures, resulting in sensory hearing loss and acute vertigo

  • Emesis resulting from acute labyrinthine dysfunction can be dangerous during an underwater dive

  • Tympanic membrane perforation is an absolute contraindication to diving because the patient will experience an unbalanced thermal stimulus to the semicircular canals, possibly leading to vertigo, disorientation, and even emesis

  • Individuals with only one hearing ear should be discouraged from diving because of the significant risk of otologic injury

When to Refer

  • For persistent or recurrent symptoms

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