Secretory otitis media is an accumulation of fluid in the middle ear.
Secretory (serous) otitis media can develop from acute otitis media that has not completely cleared or from a blocked eustachian tube (which connects the middle ear and the back of the nose). Allergies are a common cause of eustachian tube blockage. Secretory otitis media can occur at any age but is particularly common among children (see see Secretory Otitis Media in Children).
Normally, pressure in the middle ear is equalized 3 or 4 times a minute as the eustachian tube opens during swallowing. If the eustachian tube is blocked, pressure in the middle ear tends to decrease as oxygen is absorbed into the bloodstream from the middle ear. As the pressure decreases, fluid accumulates in the middle ear, reducing the eardrum's ability to move. Usually, although not always, the fluid contains some bacteria, but symptoms of active infection (such as redness, pain, and pus) are rare. People usually notice a fullness in the affected ear and may hear a popping or crackling sound when they swallow. Some hearing loss commonly develops.
A doctor examines the ear to make the diagnosis. Tympanometry (see see Testing) helps determine whether fluid is in the middle ear.
Decongestants, such as phenylephrine and ephedrine, and, in people with allergies, antihistamines can be taken to reduce nasal congestion but do not help the secretory otitis media. Antibiotics are not helpful. Low pressure in the middle ear can be temporarily increased by forcing air past the blockage in the eustachian tube. To do this, the person breathes out with the mouth closed and the nostrils pinched shut.
If symptoms become chronic (lasting more than 3 months), a doctor may perform a myringotomy, in which an opening is made through the eardrum to allow fluid to drain from the middle ear. A tiny drainage tube (tympanostomy tube—see Fig. 1: Myringotomy: Treating Recurring Ear Infections) can be inserted into the opening in the eardrum to help fluid drain and allow air to enter the middle ear.
Last full review/revision February 2008 by Richard T. Miyamoto, MD, MS