Serous Otitis Media (SOM)

Otitis media with effusion (OME) is also known as serous otitis media (SOM) or secretory otitis media (SOM), and colloquially referred to as 'glue ear'. Here, we uncover the incidence, causes, risk factors, pathogenesis, signs, symptoms, management and complications of SOM.

1. CHRONIC SEROUS OTITIS MEDIA By Dr. Sarah D’souza BDS ©

2. Otitis media with effusion (OME), also called serous otitis media, is defined as the presence of middle ear fluid without acute signs of infection. OME often occurs after acute otitis media (AOM), but it also may occur with Eustachian tube dysfunction in the absence of AOM. INTRODUCTION Synonyms: Otitis media with effusion Secretory otitis media Mucoid otitis media Glue ear

3. Most commonly seen in school going children (3-8 years age group) INCIDENCE: CAUSES: An inflammation of the adenoids A cold or allergy, which can lead to swelling and congestion of the lining of the nose, throat and eustachian tube (this swelling prevents the normal flow of air and fluids) A malformation of the eustachian tube

4. Disorders such as: Cleft palate Down syndrome Other congenital (present at birth) facial bone abnormalities Common illnesses or environmental conditions: Common cold Allergies Cigarette smoke (passive) Adenoids that are enlarged and block the auditory tube RISK FACTORS

5. PATHOGENESIS

6. Severely retracted TM with foreshortening of HOM Reduced TM mobility TM may be dull/opaque and may have an amber hue Thin leash of blood vessels along HOM/ periphery of TM Fluid level/ air bubbles may be seen Severe cases, middle ear fluid – purplish/blue - haemorrhage SIGNS

7. SYMPTOMS

8. In most cases, otitis media with effusion is diagnosed clinically on the basis of history and otoscopy findings. If investigations are required, pure tone audiometry will reveal a conductive hearing loss . Tympanometry will show a reduced membrane compliance (a type B tracing). In adults , a full ENT examination should be performed, including flexible nasoendoscopy  (to exclude a post nasal space mass). INVESTIGATIONS

9. Serous otitis media will usually resolve without any intervention. Approximately 50% of cases will resolve within 3 months; hence many cases are managed by ‘ active surveillance ’. If no resolution is seen after 3 months, the management options can be divided into surgical and non-surgical: Non-surgical – hearing aid insertion. Surgical – myringotomy and grommet insertion. In the UK, NICE guidance recommends the insertion of Grommets for those with >3months of bilateral OME and hearing level in better ear <25-30dBHL. Any child with persistent disease and multiple grommet insertion should be considered for potential adenoidectomy MANAGEMENT

10. ● Atelectasis of middle ear ● Ossicular necrosis ● Tympanosclerosis ● Retraction pockets & Cholesteatoma ● Cholesterol granuloma COMPLICATIONS