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1、Secretory otitis media,Denomination,Otitis media with effusionExudative otitis mediaMucoid otitis mediaCatarrhal otitis mediaTubotympanitisNon-suppurative otitis mediaSecretory otitis media(分泌性中耳炎),Pathology,Middle ear effusion Serofluid、Mucus、Sero-mucous，non blood or CSFEpithelium mucosae thicken，E
2、pithelial metaplasia Pseudostratified columnar ciliated epithelium Secretory epithelium,Epidemiology,Main in children5.2-21.6%（by aural speculum，Hongkong），7.3-30.7%（by acoustic impedance，Hongkong）in 2-7 year-old15-40%（2004，USA）in 1-5 year-old3.8%in 2 year-old，1.1%in 11 year-old（Suarez Nieto，1983，USA
3、）More than 50%infant occurs，most natural cure in 3 months,Etiology,Eustachian tube dysfunctionEustachian tube blockageCiliary dysfunctionInfection Immune reaction,Eustachian tube dysfunction,Disease in pharynx nasalisAdenoidal hypertrophy Nasopharyngeal carcinoma Tumour from parapharyngeal space,Cle
4、ft PalateCartilage of eustachian tube problem,Eustachian tube dysfunction,RhinosinusitisNasal polypus,Eustachian tube dysfunction,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 th
5、e main pathogenic bacteriumAlso influenzavirus、adenovirus、chalmdiae trachomatis,Immune reaction,Type I Allergic rhinitisNasal polypBronchial asthmaType III Bacterium in adenoid and pharynx oralis,Clinical manifestation,Common coldHearing disturbanceEaracheAural fullnessTinnitus,Objective sign,Ear dr
6、umHyperemia Mobility diminishedCavum tympaniFluid Air bubbles,Pure tone testConductive hearing loss,Objective sign,Objective sign,Combined deafnessBacterium or toxin reach inner ear by RWMHC hurt,Objective sign,Acoustic impedance Type B：typical plotType C：eustachian tube dysfunction,Differential dia
7、gnosis,Nasopharyngeal carcinomaUnilateral secretory otitis media，adult，lump in neck，epistaxisEpipharyngoscope，CT，MRICerebrospinal otorrheaTrauma or congenital deafnessTemporal bone CT,PerilymphorrheaStapes operation，sudden deafnessTullio phenomenonCholesterol granulomaSequela of secretory otitis med
8、ia Dark blue eardrum Temporal bone CT,Differential diagnosis,Treatment,Spontaneous cureEtilogical treatmentAdenoidectomyTonsillectomyFESS,Treatment,Drug treatmentAntibiotic Glucocorticosteroid Decongestant Ambroxol,Treatment,Eustachian tube inflation,Treatment,Tympanocentesis,Both diagnosis and trea
9、tment,Treatment,TympanocentesisSurface anesthesiaOnly adultAsepsisComplicationinfection，impairment of RWMauditory ossicle fenestration oval window,Treatment,MyringotomyCutter knifeCarbon or Dioxide laser,Treatment,Grommet insertion,Treatment,Grommet insertionIndication inefficacy of myringotomy glue ear hearing loss：40dbComplicationTympanosclerosis Permanence perforation of ear drumChronic suppurative otitis mediaSensorineural deafness,Thanks！,
