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Otitis Media (serous; with effusion)

Definition

Serous otitis media (or otitis media with effusion) consists of fluid accumulation in the middle ear without the presence of infection. To understand the pathogenesis of otitis, it is important to clarify the role of the Eustachian tube. The Eustachian tube is connecting the throat to the middle ear (the cavity filled with air behind the eardrum). The eardrum acts like a drum membrane and, to vibrate properly, both sides must be in contact with air at equal pressure. The Eustachian tube is closed at rest and opens momentarily during swallowing or yawning to allow air to come up or down from the middle ear. In other words, this tube balances the air in the middle ear and allows the eardrum to vibrate.

Due to nasal congestion, swollen tonsils or other affections, the Eustachian tube may have difficulty opening to balance the air. The middle ear starts to run out of air. Negative pressure is created, pulling the eardrum inward and limiting its potential for vibration. Subsequently, to protect itself from that pressure, the body secretes a fluid that accumulates in the cavity of the middle ear. The faulty Eustachian tube cannot drain the fluid correctly. This liquid makes the eardrum rigid and prevents it from vibrating in response to the sounds of the environment.

Children are more likely to develop more serous otitis media than adults. Their Eustachian tubes are shorter and more horizontal, which makes them prone to clogging easily with a less optimal drainage.

Manifestations

The symptoms of serous otitis media can include a hearing loss, a blocked ear sensation, and possible tinnitus. Serous otitis can reach one ear or both at the same time. It may also follow acute otitis media, the fluid remaining in the middle ear after the infection is healed. 

In children, this condition can easily go unnoticed since there is no infection, pain or fever. It is rare for a child to verbalize these symptoms. However, a change in behavior can be noted. The child may seem distracted and may not always respond when spoken to. He may avoid noisy places or group situations, have more difficulty following instructions, increase television volume, etc.

This condition can be chronic, creating a fluctuating and persistent hearing loss. It is therefore important to remain alert to the signs of otitis in children.

the audiologist’s role

The audiologist evaluates the hearing by determining the degree and nature of the hearing loss. If there is an otitis, signs of damage to the middle ear will be noted. The audiologist may offer recommendations related to nasal hygiene to try to restore (or maintain) the proper functioning of Eustachian tubes. Depending on the hearing loss noted on the exam, communication strategies can be recommended.

The audiologist can also refer the patient to the family doctor or to an ENT for a medical follow-up of the condition. Audiological monitoring may also be recommended to follow-up the hearing recovery. 

It should be noted that an audiological assessment can be performed at any age. Do not hesitate to consult, even for toddlers. Children are sensitive to the effects of hearing loss, even temporary, as it can affect the development of language and learning.

Ressources

MSSS 

Canadian Paediatric Society

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