1. 上海市第六人民医院 Shanghai Sixth People’s Hospital Secretory otitis media Shankai Yin Prof Dept of Otolaryngology, the sixth hospital affiliated to Shanghai jiaotong university Otolaryngology institute at Shanghai jiaotong university

2. 上海市第六人民医院 Shanghai Sixth People’s Hospital Denomination  Otitis media with effusion  Exudative otitis media  Mucoid otitis media  Catarrhal otitis media  Tubotympanitis  Non-suppurative otitis media…………  Secretory otitis media 1991 我国自然科学名词审定委员会

3. 上海市第六人民医院 Shanghai Sixth People’s Hospital Pathology  Middle ear effusion Serofluid 、 Mucus 、 Sero-mucous ， non blood or CSF  Epithelium mucosae thicken ， Epithelial metaplasia Pseudostratified columnar ciliated epithelium Secretory epithelium

4. 上海市第六人民医院 Shanghai Sixth People’s Hospital Epidemiology  Main in children 5.2-21.6% （ by aural speculum ， Hongkong ）， 7.3-30.7% （ by acoustic impedance ， Hongkong ） in 2-7 year-old 15-40% （ 2004 ， USA ） in 1-5 year-old 3.8% in 2 year-old ， 1.1% in 11 year-old （ Suarez Nieto ， 1983 ， USA ）  More than 50% infant occurs ， most natural cure in 3 months

5. 上海市第六人民医院 Shanghai Sixth People’s Hospital Etiology  Eustachian tube dysfunction Eustachian tube blockage Ciliary dysfunction  Infection  Immune reaction

6. 上海市第六人民医院 Shanghai Sixth People’s Hospital Eustachian tube dysfunction  Disease in pharynx nasalis Adenoidal hypertrophy Nasopharyngeal carcinoma  Tumour from parapharyngeal space

7. 上海市第六人民医院 Shanghai Sixth People’s Hospital Eustachian tube dysfunction  Circumflexus palati 、 levator palati weak  Cartilage of eustachian tube problem

8. 上海市第六人民医院 Shanghai Sixth People’s Hospital Eustachian tube dysfunction  Rhinosinusitis  Nasal polypus

9. 上海市第六人民医院 Shanghai Sixth People’s Hospital Infection  Germ in excretion of mid ear （ Senturia ， 1958 ）  22-52% positive in excretion of mid ear  Hemophilies influenzae （ 14.7% ， USA ） and micrococcus pneumoniae （ 7.0% ， USA ） are the main pathogenic bacterium  Also influenzavirus 、 adenovirus 、 chalmdiae trachomatis

10. 上海市第六人民医院 Shanghai Sixth People’s Hospital Immune reaction  Type I Allergic rhinitis Nasal polyp Bronchial asthma  Type III Bacterium in adenoid and pharynx oralis

11. 上海市第六人民医院 Shanghai Sixth People’s Hospital Clinical manifestation  Common cold  Hearing disturbance  Earache  Fural fullness  Tinnitus

12. 上海市第六人民医院 Shanghai Sixth People’s Hospital Objective sign  Deaphragma auris Hyperemia Invagination Mobility diminished  Cavum tympani Fluidify Air bubble

13. 上海市第六人民医院 Shanghai Sixth People’s Hospital Objective sign  Pure tone test Conductive hearing loss

14. 上海市第六人民医院 Shanghai Sixth People’s Hospital Objective sign  Combined deafness deafness Bacterium or toxin reach inner ear by RWM HC hurt

15. 上海市第六人民医院 Shanghai Sixth People’s Hospital Objective sign  Acoustic impedance Type B ： typical plot Type C ： eustachian tube dysfunction

16. 上海市第六人民医院 Shanghai Sixth People’s Hospital Differential diagnosis  Nasopharyngeal carcinoma Single secretory otitis media ， adult ， lump in neck ， epistaxis Epipharyngoscope ， CT ， MRI  Cerebrospinal otorrhea Trauma or congenital deafness Temporal bone CT

17. 上海市第六人民医院 Shanghai Sixth People’s Hospital  Perilymphorrhea Stapes operation ， sudden deafness Tullio phenomenon  Cholesterol granuloma Sequela of secretory otitis media Dark blue eardrum Temporal bone CT Differential diagnosis

18. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Spontaneous cure  Etilogical treatment Adenoidectomy Amygdalectomy FESS Explorative tympanotomy

19. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Drug treatment Antibiotic Glucocorticosteroid Decongestant Ambroxol

20. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Eustachian tube inflation

21. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Paracentesis tympani Both diagnosis and treatment

22. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Paracentesis tympani Surface anesthesia Only adult Asepsis Complication infection ， impairment of RWM auditory ossicle fenestration oval window

23. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Myringotomy Cutter knife Carbon Dioxide laser

24. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Grommet insertion

25. 上海市第六人民医院 Shanghai Sixth People’s Hospital Treatment  Grommet insertion Indication inefficacy of myringotomy glue ear hearing loss ： 40db  Complication Tympanosclerosis Permanence perforation of ear drum Chronic suppurative otitis media Sensorineural deafness

26. 上海市第六人民医院 Shanghai Sixth People’s Hospital Thank you