Otitis Media, Serous

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 in adults

• 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

• Tympanic membrane is dull and hypomobile

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

• Clinical

Medications

• 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; they are probably of little lasting benefit

Surgery

• 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

• Endoscopically guided laser expansion of the nasopharyngeal orifice of the eustachian tube or balloon dilation may improve function in recalcitrant cases

When to Refer

• For persistent or recurrent symptoms