CHRONIC SEROUS OTITIS MEDIA

Treatment of chronic serous otitis media may either be medical or surgical.

Medical Treatment

As the acute upper respiratory infection subsides, it may leave the patient with a persistent eustachian tube blockage. Antibiotic treatment may be indicated.

Allergy is often a major factor in the development or persistence of serous otitis media. Mild cases can be treated with antihistaminic drugs. More persistent cases may require allergic evaluation and treatment, including injection treatment.

In connection with medical treatment, often eustachian tube inflation is recommended. This is done by closing the nostrils with your fingers and blowing air toward the back of the throat while swallowing. This air goes up the eustachian tube and re-establishes the middle ear air. Children often cannot do this but often can achieve the same results by blowing balloons.

Surgical Treatment

The primary objective of surgical treatment of chronic serous otitis media is to re-establish ventilation of the middle ear, or equalize pressure of the middle ear with that in the ear canal. This keeps the hearing at a normal level and prevents recurring infections that might damage the tympanic membrane and middle ear bones. This involves a myringotomy with aspiration of fluid and insertion of a ventilation tube.

A myringotomy (incision in the eardrum) is performed to remove the middle ear fluid. A hollow plastic tube or metal tube (ventilation tube) is inserted to prevent the incision from healing and to insure middle ear ventilation. The ventilation tube temporarily takes the place of the eustachian tube in equalizing middle ear pressure. This tube usually remains in place for six to nine months, during which time the eustachian tube blockage should subside. The tubes can be removed at a later date, but most of the time it is preferable to let the tubes work their way out of the eardrum. When the tube dislodges, the eardrum heals: the eustachian tube then resumes its normal pressure equalizing function. In rare instances (less than 5% of cases) the eardrum membrane does not heal following extrusion of the tube. The perforation may be repaired at a later date if this occurs. Usually this small perforation poses no problem, as it also would act as a ventilation tube.

In adults, a myringotomy and insertion of a ventilation tube is usually performed in the office under local anesthesia, with the use of a topical solution placed on top of the tympanic membrane. In children, general anesthesia is required.

Most often when the ventilation tube is extruded there is no further middle ear ventilation problem. Should recurrent serous otitis media occur, reinsertion of a tube may be necessary. In some difficult cases it is necessary to insert a more permanent type of tube.

When a ventilation tube is in place, a patient may carry on normal activities with the exception that no water must enter the ear canal. Often this can be prevented with vaseline on a cotton ball or Silly Putty can be used to provide occlusion of the ear canal. In addition a custom made earmold will often prevent water from entering the ear canal.

One should be reminded that the purpose of a ventilation tube is not to drain the fluid in the middle ear space. This fluid is drained at the time of the surgery. The purpose of a tube is to equalize the pressures across the eardrum. This prevents the reoccurrence of fluid in the middle ear and re-establishes normal middle ear function.