Patient's question:
How is secretory otitis media formed and how is it treated? It has been half a year.Doctor's answer:
Otitis media with effusion is often secondary to upper respiratory tract infections, so it can be considered that this condition may be related to bacterial or viral infections. Suggestions for treatment: The main treatment for otitis media with effusion is to improve middle ear ventilation, drain middle ear effusion, and treat the underlying cause.(1) Improving middle ear ventilation: First, it is advisable to keep the nasal cavity and the pharyngeal orifice of the eustachian tube open. 1% ephedrine nasal drops can be used, or 1% ephedrine and 0.5% cortisone spray can be applied to the nasopharynx 3-4 times daily. Alternatively, after the acute upper respiratory tract inflammation is controlled, methods such as the (nose-pinch inflation), Boyle's ball inflation, or catheter inflation can be used to dilate the eustachian tube. Alternatively, prednisolone or other steroid hormone solutions can be sprayed into the pharyngeal orifice of the eustachian tube via a catheter to reduce local edema.
(2) Draining middle ear effusion:
① Needle aspiration: Generally, a 7 (7 long needle) is inserted into the tympanic cavity from the posterior or anterior inferior part of the tympanic membrane under sterile conditions, and the effusion is aspirated using a syringe. Alternatively, dexamethasone can be injected after aspiration.
② Tympanostomy: If the effusion is viscous and aspiration is ineffective, tympanostomy can be performed. After the tympanic membrane is incised, the effusion in the tympanic cavity is suctioned out. For viscous effusion, hyaluronidase (1000 units dissolved in 1 ml of normal saline) can be injected into the tympanic cavity.
③ Tympanostomy tube insertion: If aspiration or enzyme/steroid injections are ineffective, tympanostomy tube insertion can be performed, leaving a ventilation tube in the tympanic membrane. However, this should be used with caution in children under 2 years old. Additionally, infrared and shortwave diathermy can improve middle ear blood circulation and promote effusion absorption.
(3) Treating the underlying cause: Active treatment of nasopharyngeal and nasal diseases should be carried out, especially in cases of adenoid hypertrophy, where the adenoids may be removed. During the acute phase, erythromycin (0.25 g, three times daily, orally) or ampicillin (0.5 g, twice daily, intramuscularly) can be used to control infection. Adding dexamethasone or prednisone orally for short-term treatment can yield better results.