1. Secretory otitis media

2. Denomination Otitis media with effusion Exudative otitis media
Mucoid otitis media
Catarrhal otitis media
Tubotympanitis
Non-suppurative otitis media
Secretory otitis media(分泌性中耳炎)

3. Pathology Middle ear effusion
Serofluid、 Mucus、Sero-mucous，non blood or CSF
Epithelium mucosae thicken，Epithelial metaplasia
Pseudostratified columnar ciliated epithelium Secretory epithelium

4. Epidemiology Main in children
%（ by aural speculum，Hongkong）， %（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. Etiology Eustachian tube dysfunction Infection Immune reaction
Eustachian tube blockage
Ciliary dysfunction
Infection
Immune reaction

6. Eustachian tube dysfunction
Disease in pharynx nasalis
Adenoidal hypertrophy
Nasopharyngeal carcinoma
Tumour from parapharyngeal space

7. Eustachian tube dysfunction
Cleft Palate
Cartilage of eustachian tube problem

8. Eustachian tube dysfunction
Rhinosinusitis
Nasal polypus

9. Infection Germ in excretion of middle 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. Immune reaction Type I Type III Allergic rhinitis Nasal polyp
Bronchial asthma
Type III
Bacterium in adenoid and pharynx oralis

11. Clinical manifestation
Common cold
Hearing disturbance
Earache
Aural fullness
Tinnitus

12. Objective sign Ear drum Cavum tympani Hyperemia Mobility diminished
Fluid
Air bubbles

13. Objective sign
Pure tone test
Conductive hearing loss

14. Objective sign Combined deafness
Bacterium or toxin reach inner ear by RWM
HC hurt

15. Objective sign Acoustic impedance Type B：typical plot
Type C：eustachian tube dysfunction

16. Differential diagnosis
Nasopharyngeal carcinoma
Unilateral secretory otitis media，adult，lump in neck，epistaxis
Epipharyngoscope，CT，MRI
Cerebrospinal otorrhea
Trauma or congenital deafness
Temporal bone CT

17. Differential diagnosis
Perilymphorrhea
Stapes operation，sudden deafness
Tullio phenomenon
Cholesterol granuloma
Sequela of secretory otitis media
Dark blue eardrum
Temporal bone CT

18. Treatment Spontaneous cure Etilogical treatment Adenoidectomy
Tonsillectomy
FESS

19. Treatment Drug treatment Antibiotic Glucocorticosteroid Decongestant
Ambroxol

20. Treatment
Eustachian tube inflation

21. Both diagnosis and treatment
Tympanocentesis
Both diagnosis and treatment

22. Treatment Tympanocentesis Surface anesthesia Only adult Asepsis
Complication
infection，
impairment of RWM
auditory ossicle
fenestration oval window

23. Treatment
Myringotomy
Cutter knife
Carbon or Dioxide laser

24. Treatment
Grommet insertion

25. Treatment Grommet insertion Complication Indication
inefficacy of myringotomy
glue ear
hearing loss ：40db
Complication
Tympanosclerosis
Permanence perforation of ear drum
Chronic suppurative otitis media
Sensorineural deafness

26. Thanks！