Chronic serous otitis media, also termed chronic otitis media with effusion, is a persistent inflammatory condition of the middle ear and the leading cause of deafness and hearing loss in children. The disorder is typically seen between 3 and 7 years of age and a spontaneous resolution is observed in the majority of cases within a period of weeks to months. Without proper monitoring and treatment, however, hearing deficits can occur and further complications, such as impaired language development, could occur. The diagnosis rests on a thorough clinical assessment and appropriate diagnostic testing.
Chronic serous otitis media (often referred as chronic otitis media with effusion) is the most common cause of deafness and hearing loss in early childhood [1] [2] [3]. The pathogenesis involves the accumulation of fluid in the middle ear without damage to the tympanic membrane [2] [4]. The pathogenesis remains unclear, but bacterial microorganisms have been identified in some patients [4]. Nevertheless, an induced production of arachidonic acid metabolites, such as leukotrienes and prostaglandins, could lead to tympanic membrane damage [1].
It was established that up to 80% of all children under 10 years of age will suffer from at least one episode of otitis media with effusion, while the main patient population affected by this ear disorder is aged between 3-7 years [1] [2] [3]. The key manifestation is a bilateral hearing loss that resolves spontaneously, while some children report a tingling sensation [1] [2] [3]. Other symptoms include otalgia and a sensation of pressure in the ear [1] [3].
Acute otitis media (AOM) is often the main precipitating event in young children, whereas an infection of paranasal sinuses seems to be the main risk factor for the development of chronic serous otitis media in the adult population [2] [5]. Although the condition is benign and self-limiting in the majority of cases, many reports have emphasized the risk of inadequate language development in cases of persistent chronic serous otitis media [1] [3]. Furthermore, the vestibular function can be affected as well, producing symptoms such as poor balance and coordination [1] [2] [3].
Because chronic serous otitis media poses a significant risk for inducing deafness in early childhood, an early diagnosis is of critical importance. The first part of the diagnostic workup should be a thorough patient history during which the course of symptoms, their progression, as well as severity, should be assessed, together with a history of previous ear infections [1] [3]. In the presence of auditory complaints, the physical examination should pay special attention to the inspection of the ear, mainly through otoscopy and otomicroscopy [1] [3]. The initial findings can be retracted tympanic membrane and a shortened malleus, whereas a clear or blue-to-yellow fluid can be observed through the ear drum [3].
In serious cases, hearing testing should be conducted [1]. Conductive hearing loss ranging from 10-50 dB is mainly observed, depending on the amount and viscosity of the fluid [3]. Appropriate therapeutic strategies are designed, based on the severity of hearing loss, ranging from further testing and conservative treatment to surgery [1].