ear, nose, and throat disorders
Otitis Media (Serous)
Treatment of Serous Otitis Media
Observation If unresolved, myringotomy with tympanostomy tube insertion If recurrent in childhood, sometimes adenoidectomy For most patients, watchful waiting is all that is required. Antibiotics and decongestants are not helpful. If allergies are clearly involved, antihistamines and nasal corticosteroids may be helpful. If no improvement occurs in 1 to 3 months, myringotomy may be done for aspiration of fluid and insertion of a tympanostomy tube, which allows ventilation of the middle ear and temporarily ameliorates eustachian tube obstruction, regardless of cause. Tympanostomy tubes may be inserted for persistent Pathophysiology secondary to middle ear fluid that does not clear. Tympanostomy tubes can help prevent recurrences of Occasionally, the middle ear is temporarily ventilated with the Valsalva maneuver or politzerization. To do the Valsalva maneuver, patients keep their mouth closed and try to forcibly blow air out through their pinched nostrils (popping the ear). To do politzerization, the clinician blows air with a special syringe (middle ear inflator) into one of the patient’s nostrils and blocks the other while the patient swallows. This forces the air into the eustachian tube and middle ear. Neither procedure should be done if the patient has a cold and rhinorrhea. Patients may be instructed to gently pinch their nostrils and swallow (called autoinsufflation). This maneuver can be repeated several times throughout the day to aerate the middle ear. Persistent, recurrent serous otitis media may require correction of underlying nasopharyngeal conditions. In children, particularly adolescent boys, a nasopharyngeal angiofibroma should be ruled out; in adults, nasopharyngeal carcinoma must be ruled out. Children may benefit from adenoidectomy, including the removal of the central adenoid mass as well as lymphoid aggregations on the torus of the eustachian tube and in the Rosenmüller fossa. Antibiotics should be given for bacterial rhinitis, sinusitis, and/or nasopharyngitis. Demonstrated allergens should be eliminated from the patient’s environment and immunotherapy should be considered. Susceptible young children with prolonged hearing loss due to long-standing serous otitis may require appropriate Treatment of Hearing Loss in Children to ensure normal language development. Balloon dilation of the eustachian tube has been used as an alternative to tympanostomy tube placement ( Because environmental pressure changes can cause painful barotrauma, scuba diving and air travel should be avoided or delayed when possible. If air travel cannot be avoided, chewing food or drinking (eg, from a bottle) may help young children. A Valsalva maneuver or politzerization (during descent of an airplane, people should pinch their nose shut, hold their mouth closed, and try to blow gently out through their nose; this maneuver forces air through the blocked eustachian tube) may help older children and adults. 1.Poe D, Anand V, Dean M, et al: Balloon dilation of the eustachian tube for dilatory dysfunction: A randomized controlled trial.Laryngoscope128 (5):1200–1206, 2018. doi: 10.1002/lary.26827 Epub 2017 Sep 20. 