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3.06 Serous Otitis Media


Presentation

Following an upper respiratory infection or an airplane flight, an adult may complain of a feeling of fullness in the ears, inability to equalize middle ear pressure, decreased hearing, and clicking, popping, or crackling sounds, especially when the head is moved. There is little pain or tenderness. Through the otoscope, the tympanic membrane appears retracted, with a dull to normal light reflex, minimal if any injection, and poor motion on insufflation. You may see an air-fluid level or bubbles through the ear drum. Hearing will be decreased and the Rinne test will show decreased air conduction (i.e., a tuning fork will be heard no better through air than through bone).

What to do:

What not to do:

Discussion

Acute serous otitis media is probably caused by obstruction of the eustachian tube, creating negative pressure in the middle ear, which then draws a fluid transudate out of the middle ear epithelium. The treatment above is directed solely at reestablishing the patency of the eustachian tube, but further treatment includes insufflation of the eustachian tube or myringotomy. Fluid in the middle ear is more common in children, because of frequent viral upper respiratory infections and an underdeveloped eustachian tube. Children are also more prone to bacterial superinfection of the fluid in the middle ear, and, when accompanied by fever and pain, merit treatment with analgesics and antibiotics (e.g., ibuprofen and amoxicillin) (see above). Repeated bouts of serous otitis in an adult, especially if unilateral, should raise the question of obstruction of the eustachian tube by tumor or lymphatic hypertrophy.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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