MIDDLE EAR EFFUSION

(MEE)
OR NON-SUPPURATIVE OTITIS
MEDIA
 DEFITION
This is a disorder of the middle ear in which
the mucosal lining shows chronic
inflammatory change and an effusion which
in most cases is sterile.
Other Synonyms: Glue ear, secretory otitis
media, serous otitis media , otitis Serosa
etc.
 PATHOGENESIS
• Middle Ear effusion, arises due to changes of
middle ear pressure because of conditions that
interfere with Eustachian tube function.
• Under normal circumstances, air is being re
absorbed from the middle ear cleft, into the
mucoperiosteum. The tendency to wards
negative middle ear pressure is countered by
intermittent opening of the ET which restores
pressure back to atomospheric level.
 PATHOGENESIS CT.
• Oedema or obstruction of the ET, will lead
to negative middle ear pressure. Since
the walls of the middle ear are rigid and
hence can not collapse to counter the
negative pressure effect,fluid from
capillaries in the mucoperiosteum
transudate into the middle ear space
leading to MEE.
 AETIOLOGY
•Eustachian tube obstruction.
•Allergy.
•Upper respiratory tract infection.
•Barotrauma.
•Tumuors.
•Cleft palate.
•Radiation therapy
 ASSOCIATED FACTORS
• Bottle feeding
• Feeding while supine
• Having a sibling with otitis media
• Attending day care center
• Low socioeconomic status
• Living in a house where people smoke
• Having parental history of OME
 EUSTACHIAN TUBE
OBSTRUCTION:
The peak age incidence of MEE corresponds
to the period of maximum hyperplasia of
lymphoid tissue in the nasopharynx (2-3years)
(a) Direct closure of the ET orifice by excessive
adenoid tissue
(b) Obstruction of lymphatic vessels draining the
middle Ear and ET. This leads to mucosal
oedema and MEE.
 ALLERGY
The incidence of MEE has been found to be
twice as common in allergic children than in
a
control group. The allergic oedema act by
causing ET obstruction.
Upper Respiratory tract infection
(URTI)
Both viral and bacterial infection in the URT
may lead to ET oedema and obstruction;
and
hence MEE.
Inadequate treatment of acute purulent otitis
media results in a lingering low grade
exuadative infection.
 BAROTRAUMA
This occurs mainly in
• Air travel
• Elevetors
• Deep sea diving.
In this individuals, during descent the middle ear
pressure becomes negative with respect to
atomospheric pressure.
The ET fails to allow air in to equalize the pressure. This
leads to retraction of the tympanic membrane,ear
pain and middle ear exudate. In severe cases
capillary walls rupture leading to a bloody effusion
( haemotympanum)
 TUMOURS
Unilateral middle ear effusion should alert
the
Phycisian into the possibility of a
nasopharyngeal tumour. In this situation the
effusion is usually serous.
 CLEFT PALATE
Children with cleft palate, or who have had
cleft palate, have a higher incidence of MEE.

This is due to dysfunction of the muscles

Of the soft palate ( tensor and Levator veli
palatini muscles).These muscles also act on
the ET.
 RADIATION THERAPY
MEE is commonly found after radiation
therapy to the head and neck. This is a
serous effusion, which occurs due to
obstruction of lymphatic drainage of the
middle ear and ET.
CLINICAL FEATURES:
Conductive hearing loss.
Otalgia
Tinnitus
Dull retracted drum.
 Character of the Fluid
(1) MUCOID – Glue like
(2) Serous
(3) Bloody
(4) Purulent
 Tympanic membrane features:
(i) The normal transluscent appearance plus a
cone of light disappears. The drum becomes
dull or yellowish in colour.
(ii) The T/M becomes retracted, the incudo
stapedial joint may appear more prominent,
with apparent shortening of the handle of
malleus.
(iii) Fluid levels or bubbles may be seen through
the T/M; usually in serous effusions.
(iv) Blue tympanic membrane,this is seen in
haemotympanum.
 HEARING LOSS.
• This is the main presenting complain.
• In children:The hand cap may present as
a change in behaviour.The child becomes
dull and indifferent to command. He may
be thought of as rude by teachers or
parents.
• Adults: They will complain of hearing loss
sometimes associated with autophony
i.e.hearing of ones own voice.
 Investigations
• X-ray of the nasopharynx. To assess
adenoid hypertrophy.
• Pure tone audiometry. This will show
conductive hearing loss pattern.Stiffness
of the round window may lead to a mixed
hearing loss pattern.
• Tympanometry:Will show negative middle
ear pressure or a flat curve.
 TREATMENT
Medical treatment.
• Antibiotics.
• Decongestants.
• Antihistamines.
• Eustachian tube ventilation exercises.
 Valsava maneuver.
 Chewing gum.
 TREATMENT CT.
Surgical treatment.
• This should be performed in all children with MEE
who have not responded to medical treatment for
more than three months.
Adenotomy
• This should be performed in children with MEE
and adenoid hypertrophy
Myringotomy + tympanostomy tubes.
• In this procedure an incision is made in the lower
anterior quadrant of the tympanic membrane and
a tube inserted. This ventilates the middle ear
from the EAC.