Secretory Otitis: Symptoms – Diagnosis – Treatment

Presence of fluid in the ear: what can the causes be?

When liquid is present in the ear, it is a sign of secretory otitis. Secretory otitis is the relatively asymptomatic presence of fluid in the middle ear, without signs or symptoms of acute inflammation such as in acute otitis media. The liquid produced during secretory otitis accumulates behind the tympanic membrane, preventing the aeration of the middle ear and causing hearing loss.

What are the causes of secretory otitis?

The exact aetiopathogenesis of secretory otitis is unclear. It often follows an episode of acute otitis media, while it may also develop without prior acute otitis media, by a chronic bacterial stimulus. It mainly involves the Eustachian tube that regulates the functioning of the ear, whose obstruction causes secretory otitis. This obstruction may be due to an infection of the upper respiratory tract or to hypertrophic adenoids or allergic rhinitis, as well as to gastroesophageal reflux.

What are the potential symptoms:

Hearing loss, sense of fullness in the ears, feeling, autophony, tinnitus, squeaky sound in the ear when swallowing, yawning or sneezing. Coexisting imbalance may be noted in chronic cases.

Secretory otitis and diagnosis in the clinic:

Through a full audiology test, the ENT specialist will be able to ascertain if these symptoms are due to secretory otitis. The clinical examination and the audiology test, which includes a tympanogram and an audiogram, will give the specialist a full picture of the problem, to allow for the appropriate treatment strategy to be followed.

Secretory otitis in children:

As early as in infancy, children can present many ENT-related problems, especially ear infections. This is due to the different anatomy of children, the different position of the Eustachian tube, which makes them predisposed to viral or bacterial infections in the middle ear.

Furthermore, their close proximity with other children at school and kindergarten favours the development of viral diseases, as their body’s defence against pathogens is not fully developed.

Secretory otitis is very common in children aged 2 to 5 years, decreases with age and is the most common cause of hearing loss in children.

In children, it is usually asymptomatic and is discovered by their teachers or parents, who notice that the child does not hear well, sets the volume on the TV very loud, or presents a delay in speech development. Doctors may also discover it incidentally during a clinical examination.

It is very important to manage the problem promptly, to avoid relapses or chronic conditions that can cause permanent hearing loss. Besides, the age at which it presents in children is crucial for the development of speech, which means that any hearing problem must be directly managed, to avoid affecting the child’s overall development.

The relationship between Eustachian tube dysfunction and fluid collection in the ear with hypertrophied adenoids:

The orifices of two tubes, called the Eustachian tubes, which significantly regulate the operation of the ear, are located next to the adenoids. When the nasal adenoids are hypertrophic or frequently lead to inflammations, the ears are greatly affected. Many children present frequent ear infections because of hypertrophic adenoids. When ear infections persist, they can cause many problems, especially hearing loss, which in turn may lead to delayed speech development and speech disorders.

How is secretory otitis treated:

It is initially treated with conservative treatment with the Valsalva manoeuvre, and in children with insufflation devices, with balloons or by chewing gum, to open the Eustachian tube. Usually, otitis automatically resolves within 3 months. If not resolved and the hearing loss is> 40 dB surgical intervention is required to restore hearing (delay of speech in children) with incision of the tympanic membrane and placement of eardrum drain tubes to provide adequate ventilation in the middle ear and adenoidectomy.

In adults, especially if secretory otitis occurs without a prior cold, the oropharynx should also be examined, either by posterior rhinoscopy or by a CT scan to exclude the presence of a malignancy in the nasopharynx.

Surgical treatment of secretory otitis – Combination with Adenoidectomy & Tonsillectomy

In cases of frequent ear infections caused by large adenoids, the doctor may suggest drum puncture (perhaps by placement of eardrum drain tubes) combined with adenoidectomy. It is an operation performed under general anaesthesia and through the mouth, without incisions. The incision is made with a microscope and the surgeon decides, depending on the composition of the fluid, whether to place a drain tube in the eardrum. The drain tube falls out on its own within about a year and during this period, water ingress in the ears should be avoided. If the child suffers from hypertrophic tonsils or presents frequent infection episodes, tonsillectomy can be performed during the same operation. Combined puncture and adenoidectomy takes about one hour, while if tonsillectomy is also performed, it takes about an hour and a half.

Is it a difficult operation?

Thanks to technological developments, puncture combined with adenoidectomy and tonsillectomy use new endoscopy methods using radio frequencies, so the procedure is not as laborious and bloody as it used to be. This leads to less pain, instant healing and almost no hospitalisation, which is very important for the child.

After surgery:

After surgery, the child can return home immediately, on the same day or the next morning if tonsillectomy has also been performed. It has no stitches and is not in much pain; for a few days, it will follow the postoperative instructions the doctor provides (antibiotics for preventive purposes), painkillers and mashed, lukewarm food. Parents should ensure that the child follows the postoperative instructions, to allow it to return to its daily activities very soon.

Frequently Asked Questions

How can I protect my child from otitis?

It is very important for the child not to be exposed to areas where people smoke, and that parents completely avoid smoking at home, to avoid exposing the child to the risks of passive smoking. Furthermore, although it is difficult to avoid placing the child in kindergarten when both parents work, try to find a kindergarten with small classes and ensure the child is promptly vaccinated, to protect it as much as possible from the risk of infection from other children. Also make sure to wash its hands and toys often. Finally, it is advisable to carefully monitor the symptoms of a child that has suffered from otitis in the past, because children who have gone through otitis in the past are more prone to present it again.

Are certain seasons associated with otitis?

Cases of secretory and acute otitis media are very common in winter, especially in children, while external otitis is more usual in summer. In winter, especially due to their close proximity with other children at school and kindergarten, it is much more probable that children may present a viral infection or a cold, thus increasing the chances of secretory or acute otitis media as a direct result of the inflammation. In summer, the moisture that remains in the child’s ear after frequent baths and swimming in the sea and pools favours the transfer and development of bacteria in the external auditory meatus, causing external otitis.

How can I prepare my child for testing?

In a very simple and understandable way, tell it you will visit the doctor to make it well and that it will not hurt, so there is nothing to fear. An experienced paediatric ENT knows how to approach a child that visits the clinic for the first time, to develop a relationship of trust and cooperation from the beginning. Following a different approach, the doctor’s movements during the examination – which often scare the child – can be turned into a game.

How can I prepare my child for surgery?

When preparing the child for an operation, you should be calm, honest and use very simple words. In no case should you provide technical details that do not concern it and will scare it. Be as honest and calm as possible, making the child feel safe and trustful in that you are telling the truth, stressing that the surgery will be for its own good, to allow it to hear and breathe better, so that it can run and play freely after this and have a better time when playing with its friends and you. Depending on the child’s age and personality, you can tell it what a hospital is, mainly through playing, but even using a sketch or a story with its favourite hero. This will associate it with positive images and the child’s fear and stress will be reduced.

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