The Effective and Rational Treatment of Secretory Otitis Media

In the absence of any acute otological symptoms including pain and temperature, a middle ear effusion in association with hearing loss has been designated by various names, i.e. catarrhal otitis, exudation otitis, serous otitis, nonsuppurative otitis, glue ear, and currently the most fashionable terms, otitis media with effusion and secretory otitis media. A middle ear effusion without inflammatory clinical manifestations is, however, not an otitis; but rather, a sequela to an otitis of more than one possible cause. It may also be associated with atelectatic tympanic membranes, barotrauma, Wegener’s granulomatosis, and carcinoma of the nasopharynx. The most important reason for using the appropriate nomenclature is for the sake of a more precise communication and of a better insight into this entity and its treatment: the term ‘otitis’ may suggest an active inflammatory process that requires anti-inflammatory treatment, which is usually not the case in the presence of a banal middle ear effusion. The most appropriate term for middle ear effusion in general is “sequela to otitis media” as middle ear effusions in children are mainly a sequela to viral otitis media, while those seen in younger children (1-2 years old) are mostly secondary to bacterial otitis media. Last but not least, chronic secretory otitis media is not a sequela to a previous middle ear inflammation and its etiology is still obscure. From the Ear Research Laboratory, Department of Biomedical Engineering, Sackler School of Medicine, Tel-Aviv University, Israel.