A persistent collection of fluid in the middle ear
- More common under the age of 5
- More common in boys
- Passive smoking is a probable risk factor
- Genetics is not a significant factor
In chronic secretory otitis media, the middle ear becomes filled with a thick, sticky, glue-like fluid. The condition is more common in boys and is the most common cause of impaired hearing in children under the age of 5. Since the disorder can be persistent and usually occurs at a stage of a child’s development when good hearing is essential for learning to speak, it may cause a delay in speech development and in the normal acquisition of language skills.
What are the causes?
The middle ear is normally ventilated by the eustachian tube (the narrow tube that connects the middle ear to the back of the throat). However, if this tube becomes blocked, possibly as a result of infection (see Acute otitis media in children), the middle ear may fill with fluid. Often the blockage persists, causing chronic secretory otitis media. In some cases, the cause of the blockage is unknown. However, the disorder is thought to be more common in children whose parents smoke. Children who have asthma or allergic rhinitis are also more susceptible to chronic secretory otitis media. Children born with Down’s syndrome or a cleft lip and palate are also at an increased risk of developing the disorder.
What are the symptoms?
In most cases, symptoms develop gradually and may initially go unnoticed. The symptoms often fluctuate and tend to be worse in winter. They may include:
Partial hearing loss.
Immature speech for the child’s age.
Behavioural problems due to frustration at being unable to hear well.
You may notice that your child is sitting close to the television or turning up the volume. His or her school performance may suffer because of difficulty hearing. If you suspect a hearing problem, you should consult the doctor without delay.
How is it diagnosed?
The doctor will examine your child’s ears and may then refer him or her to a specialist. Depending on the age of your child, various hearing tests may be performed (see Hearing tests in children). The specialist may also perform a test in which air is blown into the affected ear using a special instrument. This test is carried out to measure the amount of movement of the eardrum, which is reduced in chronic secretory otitis media. Since the condition can fluctuate, the specialist will probably wish to examine your child again after about 3 months, when the tests will be repeated. Allergy tests may also be recommended.
What is the treatment?
In most cases, chronic secretory otitis media clears up without treatment. If symptoms persist for several months, an operation may be advised. During the procedure, a small plastic tube called a grommet is inserted in the eardrum (see Grommet insertion). The tube allows air to enter and circulate around the middle ear, drying it out. Some children with chronic secretory otitis media also have enlarged adenoids, which may be removed in the same operation (see Tonsillectomy and adenoidectomy).
What is the prognosis?
As a child grows, the eustachian tubes widen, allowing fluid to drain away from the middle ear more efficiently. As a result, the eustachian tubes are much less likely to become blocked. Chronic secretory otitis media is therefore rare in children over the age of 5.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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