1、Secretory otitis mediaDenomination 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)Pathologyo Middle ear effusionn Serofluid、 Mucus、Sero-mucous，non blood or CSFo Epithelium mucosae
2、thicken，Epithelial metaplasian Pseudostratified columnar ciliated epithelium Secretory epitheliumEpidemiology 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
3、 Nieto，1983，USA） More than 50% infant occurs，most natural cure in 3 monthsEtiology Eustachian tube dysfunction Eustachian tube blockage Ciliary dysfunction Infection Immune reaction Eustachian tube dysfunction Disease in pharynx nasalis Adenoidal hypertrophy Nasopharyngeal carcinoma Tumour from para
4、pharyngeal space pCleft PalatepCartilage of eustachian tube problemEustachian tube dysfunction Rhinosinusitis Nasal polypusEustachian tube dysfunctionInfection Germ in excretion of middle ear（Senturia，1958） 22-52% positive in excretion of mid ear Hemophilies influenzae （14.7%，USA）and micrococcus pne
5、umoniae （7.0%，USA） are the main pathogenic bacterium Also influenzavirus、adenovirus、chalmdiae trachomatisImmune reaction Type I Allergic rhinitis Nasal polyp Bronchial asthma Type III Bacterium in adenoid and pharynx oralisClinical manifestation Common cold Hearing disturbance Earache Aural fullness
6、 Tinnitus Objective sign Ear drum Hyperemia Mobility diminished Cavum tympani Fluid Air bubbles Pure tone test Conductive hearing loss Objective signObjective signCombined deafnessnBacterium or toxin reach inner ear by RWMnHC hurtObjective sign Acoustic impedance Type B：typical plot Type C：eustachia
7、n tube dysfunctionDifferential diagnosis Nasopharyngeal carcinoma Unilateral secretory otitis media，adult，lump in neck，epistaxis Epipharyngoscope，CT，MRI Cerebrospinal otorrhea Trauma or congenital deafness Temporal bone CT Perilymphorrhea Stapes operation，sudden deafness Tullio phenomenon Cholestero
8、l granuloma Sequela of secretory otitis media Dark blue eardrum Temporal bone CT Differential diagnosisTreatment Spontaneous cure Etilogical treatmentAdenoidectomyTonsillectomyFESSTreatment Drug treatment Antibiotic Glucocorticosteroid Decongestant AmbroxolTreatment Eustachian tube inflation Treatme
9、nt TympanocentesisBoth diagnosis and treatmentTreatment Tympanocentesis Surface anesthesia Only adult Asepsis Complicationinfection，impairment of RWMauditory ossicle fenestration oval windowTreatment Myringotomy Cutter knife Carbon or Dioxide laserTreatment Grommet insertionTreatment Grommet insertion Indicationp inefficacy of myringotomyp glue earp hearing loss ：40dbpComplication Tympanosclerosis Permanence perforation of ear drum Chronic suppurative otitis media Sensorineural deafnessThanks！
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