Management of Secretory Otitis Media: A Comparative study.

Secretory otitis media is the most common cause of hearing impairment in children. It is defined as the persistence of serous or mucoid middle ear effusion for 12 weeks or more. It is also called as otitis media with effusion, catarrhal otitis media, exudative otitis media, seromucinous otitis media, non-suppurative otitis media. The term secretory is appropriate as it reflects a particular aspect of pathological process. The term otitis media with effusion allows differentiation of the type of effusion and facilitates distinction into serous and mucinous, acute and chronic forms. In many children,secretory otitis media is preceded by an episode of acute otitis media.This is true especially in younger children because of the higher incidence of upper respiratory tract infection. Acute otitis media is usually triggered by a viral respiratory tract infection which damages the epithelium of Eustachian tube, resulting in retention of middle ear fluid. Hence secretory otitis media will be present temporarily in many children after an episode of acute otitis media. From our study it is evident that secretory otitis media is a treatable cause of conductive hearing loss in children. In children, Eustachian tube dysfunction was secondary to functional or mechanical obstruction was the common precipitating factor for secretory otitis media. GERD was found to be associated with almost all adult patients. It has to be studied whether control of acid reflux can have any effect in these patients. From our study it was evident that medical management helps in the control of acute episodes of secretory otitis media which is associated with frequent relapse and recurrence. Surgical management in the form of adenoidectomy / myringotomy with grommet insertion has better long term outcome in terms of hearing impairment and disease relapse and recurrence. In our study we used Shepards tympanostomy tubes which was associated with extrusion rate of 10% at 3 months follow up period. Further studies are needed to compare the efficacy of various tympanostomy tubes on disease control and various complications. A long term follow up is needed to assess the disease relapse and recurrence, also to study the various sequlae of secretory otitis media like adhesive otitis media and cholesteatoma.