OVERVIEW

What is the middle ear?

The ear is divided into three parts: the outer ear, middle ear, and inner ear. The eardrum separates the outer ear (our visible ear, ear canal, and external auditory canal) from the middle ear, which is the cavity between the eardrum and the ossicles.

What is secretory otitis media?

The middle ear has a complex and winding structure, making it prone to inflammation. Secretory otitis media is a common type of middle ear inflammation, also known as non-suppurative otitis media, exudative otitis media, serous otitis media, mucous otitis media, or catarrhal otitis media.

Secretory otitis media is characterized by middle ear effusion and hearing loss, commonly seen in children, often following upper respiratory infections. It can cause hearing loss in children, affecting language development, so prompt attention and treatment are essential. For adults with unilateral cases, early diagnosis to rule out tumors is crucial to avoid delayed treatment.

The treatment principle for secretory otitis media is actively addressing the cause, improving Eustachian tube function, relieving middle ear negative pressure, draining effusion, and preventing complications. Most cases can recover with timely and effective treatment.

What are the types of secretory otitis media?

• Based on duration, secretory otitis media can be classified as acute or chronic. Cases lasting over 3 months are considered chronic secretory otitis media.

• Depending on the nature of the effusion, it can also be categorized as exudative otitis media, non-suppurative otitis media, mucous otitis media, catarrhal otitis media, or serous otitis media.

Is secretory otitis media the same as suppurative otitis media?

No, they are distinctly different. Secretory otitis media does not involve pus formation.

Secretory otitis media can develop secondary bacterial infections, turning into suppurative otitis media. Additionally, during tympanostomy tube placement (inserting a hollow tube into the eardrum to drain secretions), bacteria may enter the middle ear through the tube, causing suppurative otitis media.

SYMPTOMS

What are the symptoms of secretory otitis media?

• Hearing loss: It may worsen or improve with changes in body position. Children with the condition may not express it clearly, leading to delayed diagnosis.

• Ear pain: Usually mild.

• Tinnitus: Generally not severe, may be intermittent, and manifest as a "crackling" or bubbling sound.

• Fullness or blockage in the ear: More noticeable in adults, sometimes temporarily relieved by pressing the tragus.

Secretory otitis media often occurs in children. How can parents detect it early?

Since ear pain is not obvious and children may struggle to describe their symptoms clearly, parents often only seek medical attention when hearing loss occurs, leading to delayed diagnosis and treatment. Therefore, parents should pay attention to their child's daily behavior for early detection and timely intervention. Watch for the following signs:

• Infants and toddlers may show poor or no response to surrounding sounds, fail to turn their head toward the sound source, or exhibit symptoms like ear tugging, restless sleep, and irritability.

• Even if a child does not complain of hearing loss, be alert if they appear inattentive, show behavioral changes, fail to respond to normal conversation, or frequently turn up the volume on TVs or audio devices.

• Children may experience poor academic performance, balance issues, unexplained clumsiness, or delayed speech and language development.

• For children with recurrent acute otitis media, be vigilant for secretory otitis media during remission periods.

What serious complications can secretory otitis media cause?

Secretory otitis media may progress to adhesive otitis media (tissue adhesion in the tympanic cavity), tympanosclerosis, cholesterol granuloma, or acquired primary cholesteatoma. Without timely treatment, these conditions can lead to severe hearing loss and other complications.

Why should secretory otitis media in adults be given special attention?

Because it may indicate the presence of malignancy.

Typical early symptoms of nasopharyngeal carcinoma include blood-stained nasal discharge and neck lumps, but some patients first present with ear symptoms, such as unilateral secretory otitis media (since tumors usually occur on one side).

Therefore, adults with unilateral secretory otitis media should be highly suspected of nasopharyngeal cancer. Even if nasopharyngeal endoscopy appears normal, regular follow-ups are necessary. Contrast-enhanced CT scans of the nasopharynx may be required to avoid missing a cancer diagnosis.

CAUSES

What causes secretory otitis media?

The exact cause of this disease is not yet fully understood, but possible reasons include:

• Dysfunction of the Eustachian tube: The middle ear needs to maintain normal air pressure, which is regulated by the Eustachian tube. When the Eustachian tube becomes blocked for various reasons, the middle ear experiences negative pressure, causing the veins in the middle ear mucosa to dilate. The vessel walls become thinner and more permeable, allowing fluid to leak and accumulate in the middle ear, leading to effusion.

• Infection: Previously, this condition was considered a sterile inflammation. However, with advancements in testing technology, various pathogens, including bacteria and viruses, have been detected in middle ear effusions.

• Immune response: Immunological tests on effusions suggest that secretory otitis media may be related to immune reactions, as certain immune responses can increase middle ear secretions and exude specific fluids.

• Other factors: Smoking, improper breastfeeding techniques (e.g., a baby's head positioned too low while nursing, allowing milk to flow into the ear), and a family history of otitis media are all risk factors for secretory otitis media.

Is secretory otitis media related to the common cold?

Yes.

The common cold is caused by viral infections and may also involve bacterial infections. These pathogens can enter the Eustachian tube through nasal and throat secretions (especially when blowing the nose forcefully) and eventually reach the middle ear, leading to secretory otitis media. Additionally, the body's weakened immunity during a cold is another factor that increases susceptibility to this condition.

Therefore, the common cold is closely related to secretory otitis media.

Is secretory otitis media related to rhinitis or sinusitis?

Yes.

Rhinitis and sinusitis are significant causes of otitis media. The nasal mucosa is connected to the Eustachian tube mucosa. During rhinitis or sinusitis, purulent nasal secretions can directly irritate the Eustachian tube mucosa and spread to the middle ear, causing inflammation.

Other nasal issues, such as hypertrophy of the posterior end of the inferior turbinate, posterior nasal polyps, or tumors, can also narrow or block the Eustachian tube, affecting middle ear pressure and leading to secretory otitis media.

If nasal conditions are left untreated, prolonged Eustachian tube blockage can develop into chronic secretory otitis media.

Can secretory otitis media be caused by flying or diving?

Yes. This type of secretory otitis media is called "barotraumatic otitis media." Cases caused by flying are termed aerotitis media, while those caused by diving are called diver's ear.

During takeoff, landing, or diving, rapid changes in atmospheric pressure occur. If the Eustachian tube fails to open promptly to regulate middle ear pressure, the middle ear may experience relative positive or negative pressure, leading to barotrauma.

Mild cases may result in middle ear effusion or even hemotympanum, while severe cases can cause eardrum rupture, intense ear pain, tinnitus, dizziness, nausea, and hearing impairment.

Why is secretory otitis media more common in children?

• Underdeveloped Eustachian tube: In children, especially infants, the Eustachian tube is shorter, wider, and positioned lower, making it less functional.

• Immature immune system: Children have weaker immunity, making them more prone to colds, nasopharyngitis, sinusitis, and tonsillitis, which, if untreated, can lead to otitis media.

• Improper feeding: Incorrect feeding positions can cause choking or vomiting, allowing milk or water to enter the middle ear and trigger otitis media.

• Embryonic remnants: Newborns may have residual embryonic tissue in the tympanic cavity, increasing the risk of bacterial infection or otitis media due to amniotic fluid entering the middle ear.

DIAGNOSIS

What diseases should secretory otitis media be differentiated from?

Secretory otitis media shares similar manifestations with many diseases but requires different treatments, thus necessitating differentiation:

• Acute suppurative otitis media: Acute suppurative otitis media typically has a shorter course, with symptoms such as severe ear pain and ear discharge. In contrast, secretory otitis media has a longer duration, primarily presenting with ear fullness, intermittent and milder ear pain, or even no ear pain.

• Nasopharyngeal carcinoma or nasopharyngeal tumors: Early symptoms of typical nasopharyngeal carcinoma may include blood-stained nasal discharge and neck masses. However, some patients initially exhibit symptoms of secretory otitis media, as the tumor may grow submucosally in the nasopharynx, making it difficult to detect early via nasal endoscopy. Therefore, unilateral secretory otitis media in adults should be highly suspected.

• Chronic suppurative otitis media with cholesteatoma: In this condition, cholesteatoma-like substances form in the middle ear, potentially covering a perforation in the pars flaccida with cholesteatoma crust. Otoscopic examination may not easily distinguish it, necessitating high-resolution temporal bone CT to rule out middle ear cholesteatoma.

• Spontaneous or traumatic cerebrospinal fluid otorrhea: Examination reveals fluid accumulation in the tympanic cavity, resembling secretory otitis media. Diagnosis is confirmed based on medical history, physical examination, and imaging. Traumatic cases have a clear history of injury.

• Perilymphatic fistula: Rupture of the inner ear or congenital fissures allows perilymph to leak into the middle ear cavity, manifesting as tympanic effusion. However, patients may have a history of vertigo triggered by loud sounds, and hearing tests indicate sensorineural hearing loss (sound transmission to the brain involves two steps: the outer and middle ear contain structures like a speaker, drum, and hammer, while the inner ear consists of nerve pathways akin to telephone wires. Issues with the latter result in neural hearing loss, including abnormalities in auditory hair cells, the auditory nerve, or auditory centers).

• Cholesterol granuloma: Patients complain of hearing loss and ear fullness. Otoscopy may reveal a bluish tympanic membrane, while temporal bone CT shows narrowing of the tympanic antrum entrance and possible bone destruction. Surgical exploration and pathological examination can confirm the diagnosis.

• Other rare diseases: Such as nasal malignant granuloma, Ménière's disease, and superior semicircular canal dehiscence syndrome.

What tests are needed for secretory otitis media?

The following tests are primarily used to diagnose secretory otitis media and rule out other conditions:

• Tympanic membrane examination: Conducted using a pneumatic otoscope or otoscope, revealing tympanic membrane retraction and a color change from normal grayish-white translucency to amber or orange. The presence of an air-fluid level or bubbles is more typical.

• Hearing test: Typically shows conductive hearing loss (reduced hearing due to obstruction in sound transmission to the inner ear), which may fluctuate.

• Tympanometry: Measures the response of middle ear structures to sound, assessing middle ear function. Tympanometry is highly valuable for diagnosing this condition, with secretory otitis media typically presenting as a "flat tympanogram."

• Imaging tests: Temporal bone CT may be selected based on individual circumstances, though not required for every patient.

TREATMENT

Which department should I visit for secretory otitis media?

Otology or otolaryngology (ENT).

How is secretory otitis media treated?

Conservative treatment is the first approach, followed by surgical options if ineffective.

What are the specific conservative treatment methods for secretory otitis media?

• Antibiotics: For acute cases, appropriate antibiotics may be used short-term based on severity.

• Maintaining nasal and Eustachian tube patency: Nasal corticosteroid sprays are commonly used with minimal side effects. Drugs like ambroxol hydrochloride can regulate mucosal function in the Eustachian tube and middle ear, promoting fluid drainage and improving mucus clearance.

• Oral corticosteroids: For patients without contraindications, short-term oral corticosteroids like prednisone may be used, but long-term use is not recommended.

• Eustachian tube inflation: Methods like autoinflation, Valsalva maneuver, or catheterization can help open the Eustachian tube. However, nasal inflammation must be absent to avoid spreading infection and causing acute suppurative otitis media.

Note: Conservative treatment for children differs slightly from adults and should be guided by a doctor.

What surgical treatments are available for secretory otitis media?

• Tympanocentesis: A needle punctures the eardrum to drain fluid, improving middle ear ventilation. Repeat procedures or corticosteroid injections may be used to reduce fluid reaccumulation.

• Myringotomy: A small incision is made in the eardrum to drain thick secretions, often performed under general anesthesia in children.

• Tympanostomy tube placement: A tube is inserted into the eardrum to drain fluid, suitable for chronic or recurrent cases. Tubes typically remain for 3–6 months, up to a year.

• Eustachian tube laser surgery and balloon dilation: These emerging techniques aim to restore Eustachian tube function but require further evaluation.

• Mastoidectomy and tympanotomy: For refractory cases with complications or suspected granulation tissue obstruction, surgery with tube placement may be performed.

Note: Children may recover spontaneously; a 3-month observation period is recommended before surgery.

Does tympanocentesis affect hearing?

The procedure carries minimal risk and generally does not harm hearing.

What should I care about after tympanostomy tube placement?

Regular follow-ups are needed to check for tube blockage or displacement. Tubes are removed once Eustachian tube function recovers, usually after 3–6 months.

Are tympanocentesis and tube placement painful?

Adults can undergo these procedures under local anesthesia; general anesthesia is an option for pain-sensitive individuals. Children usually require general anesthesia.

Can secretory otitis media resolve on its own?

In children, it is often self-limiting and may resolve without treatment. A 3-month observation period is advised before surgery. Adults should identify underlying causes, including ruling out malignancies.

Why might adenoid or tonsil removal be needed?

Inflamed or enlarged adenoids/tonsils can block the Eustachian tube, necessitating surgery to address the root cause.

Why treat nasal issues for secretory otitis media?

Nasal conditions (e.g., sinusitis, polyps) can contribute to the disease. Treating nasal issues ensures Eustachian tube function and aids recovery.

Are there quick remedies like ear powders?

Powders cannot penetrate an intact eardrum. Traditional remedies lack proven efficacy, so they are not recommended.

Can secretory otitis media be fully cured?

Early, proper treatment usually leads to recovery. Delayed cases may cause complications like hearing loss, so consistent medical care is crucial.

DIET & LIFESTYLE

What issues should patients with secretory otitis media pay attention to after tympanostomy tube placement?

• Use ear drops cautiously, especially viscous ones, to avoid affecting drainage.

• If there is nasal inflammation, it should be treated simultaneously.

• Closely observe local and systemic conditions to prevent colds.

• Exercise moderately and avoid strenuous activities that may cause tube displacement or even detachment.

• Maintain local hygiene and prevent water from entering the ear canal to avoid acute suppurative otitis media.

• Avoid spicy and highly irritating foods.

What dietary considerations should be noted for secretory otitis media?

Maintain a balanced and nutritious diet. Special attention should be paid to:

• Avoid highly irritating foods such as chili peppers, and refrain from smoking and alcohol, as these may increase secretion from the middle ear mucosa.

• Ensure a well-balanced intake of high-quality protein, vitamins, minerals, and dietary fiber, and avoid picky eating.

PREVENTION

How to Prevent Secretory Otitis Media?

• Strengthen exercise, enhance physical fitness, and prevent colds.

• Maintain a balanced diet and avoid highly irritating foods that may increase secretions.

• Avoid exposure to smoke and other harmful gases that irritate the respiratory tract, and protect and enhance the resistance of the upper respiratory mucosa.

• Prevent and treat allergic diseases, and avoid contact with allergens.

• Blow the nose correctly. When blowing the nose, do not pinch both nostrils tightly and blow forcefully. Instead, press one nostril gently to clear nasal secretions, or spit them out through the mouth.

• Feed infants and young children in the correct position, ensuring the head is not too low to prevent food such as milk from entering the tympanic cavity through the Eustachian tube, which may cause otitis media.