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Chronic Serous Otitis Media

Chronic Serous Otit Media

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].

Surgical Procedure
  • Intradermal skin testing was done by the Rinkel technique under general anesthesia in conjunction with myringotomy and associated surgical procedures.[ncbi.nlm.nih.gov]
  • Surgery If the ear infection did not respond to the treatment or is recurring, a surgical procedure may be advised by the physician.[ehealthhall.com]
  • This surgical procedure involves making a small opening in the eardrum to drain the fluid and relieve the pressure from the middle ear.[chop.edu]
  • Surgical There is a paucity of up-to-date evidence of surgical procedures for CSOM [ 13 ].[patient.info]
  • If your child continues to suffer infections despite antibiotic treatment, the doctor may recommend a surgical procedure to place tubes in your child’s ears, allowing air to flow into the middle ear and prevent fluid buildup in the middle ear.[medicalhearingsystems.com]
Recurrent Upper Respiratory Infection
  • All cases of recurrent upper respiratory infections and frequent flare-ups of allergies may induce repeated inflammation and chronic serous otitis media.[ic.steadyhealth.com]
  • The incidence of these pathogens are higher in children under the age of 2, and in children with recurrent upper respiratory infections. Investigations: Puretone audiometry: Demonstrates mild to moderate conductive deafness.[drtbalu.co.in]
  • Weak immune system and pathogens The interplay between the pathogens and the weak immune system is important in the development of OM. This infection thrives in individuals with decreased immune defense.[ehealthhall.com]
  • In the majority of cases, the cause is related to dysfunction of the eustachian tube due to viral or bacterial rhinitis and occasionally to nasopharyngeal tumors.[ncbi.nlm.nih.gov]
  • View Abstract View Abstract View Abstract (These drugs may still be effective in children with a rhinitis or allergic nasal symptoms and by clearing the nasal symptoms.[entusa.com]
  • There is increasing evidence to suggest that allergic rhinitis and otitis media coexsist. It has been reported that up to 30-45% of patients with allergic rhinitis have otitis media.[bmj.com]
  • J301Allergic rhinitis due to pollen J302Other seasonal allergic rhinitis J305Allergic rhinitis due to food J3081Allergic rhinitis due to animal (cat) (dog) hair and dander J3089Other allergic rhinitis J309Allergic rhinitis, unspecified J310Chronic rhinitis[cms.gov]
  • Learn More About Topic Tinnitus Over 50 million Americans have experienced tinnitus, or ringing in ears, which is the perception of sound without an external source being present.[entnet.org]
  • Tinnitus is a condition most commonly known as ringing in the ears, but it can also present as humming, buzzing, or hissing. We are one of the few practices that specializes in tinnitus treatment in Boca Raton, Florida.[labyrinthaudiology.com]
  • Meniere’s disease is associated with attacks of vertigo (a sensation of spinning) and/or tinnitus, fullness in the ear and hearing loss. A sensorineural hearing loss is associated with Meniere’s disease and in most cases only one ear is affected.[deafness.org.au]
  • Typically caused by a virus and less commonly bacteria, common symptoms include dizziness, vertigo, loss of balance, flickering of the eyes (nystagmus), and tinnitus or hearing loss. Labyrinthitis is classified to subcategory 386.3.[fortherecordmag.com]
  • Other symptoms include otalgia and a sensation of pressure in the ear.[symptoma.com]
  • Head and neck symptoms Children may show signs of earache or otalgia through the pulling of the affected ear.[ehealthhall.com]
  • In acute otitis media, otalgia is the most common complaint. Other common signs and symptoms include otorrhea, hearing loss, headache, fever, and irritability.[radiopaedia.org]
  • The occurrence of subsequent fever, otalgia, and unscheduled medical visits were not significantly different between the groups. Further analysis showed that fever and otalgia were predictors of filling the antibiotic prescription in the WASP group.[raysahelian.com]
  • Browning GG: Childhood Otalgia: Acute Otitis Media. Brit. Med. J., 300:1005, 1990. Pulek JL and Horwitz MJ: Diseases of the Eustachian Tube. Otolaryngology, Philadelphia, W.B. Saunders, 2:75-92, 1972. Peter N. Fysh, D.C.[dynamicchiropractic.com]
Hearing Problem
  • One common symptom of OME is hearing problems. In younger children, behavior changes can be a symptom of hearing problems. For example, a child may turn the television up louder than usual. They may also tug or pull on their ears.[healthline.com]
  • Fortunately, despite ear infections being the most common disease of childhood, permanent speech and hearing problems are rare.[entsurgicalillinois.com]
  • This review summarizes the studies using antihistamines, decongestants or a combination of antihistamines and decongestants and finds no benefit for any of the short or long-term outcomes including resolution of the fluid, hearing problems or the necessity[cochrane.org]
  • In the early stages, SOM causes a hearing problem, but as time goes on, the trapped fluid may become infected with bacteria and cause further complications.[medicalhearingsystems.com]
  • Your child may have a hearing test done at that visit, (especially if they are over 2 or have speech or hearing problems); there is a charge for this test as well as any ear plugs or head bands you purchase.[entcentergr.com]
Ear Discharge
  • Chronic Suppurative Otitis Media Chronic Suppurative OM is a result of an episode of an acute OM but is characterized by a persistent ear discharge due to the perforation of the tympanic membrane.[ehealthhall.com]
  • Discharge 258 Intravenous Antibiotics for Otorrhea 261 Evaluation and Treatment of Recurrent PostTympanostomy Otorrhea 266 Workup and Management of Chronic Otorrhea 271 MethicillinResistant Staphylococcus aureus Otorrhea 278[books.google.de]
  • In more severe cases the symptoms include hearing loss, earache or pain, dizziness, high fever, ear discharge, nausea and tinnitus. In some cases the eardrum cannot withstand the increasing pressure from the buildup of fluid and tears.[hear-the-world.com]
Progressive Hearing Loss
  • hearing loss due to more spicules.[quizlet.com]
  • Otosclerosis causes a progressive hearing loss which usually starts in the mid 30’s. The hearing loss from otosclerosis can be conductive, mixed or sensorineural depending on where the bone growth occurs.[deafness.org.au]
  • The key manifestation is a bilateral hearing loss that resolves spontaneously, while some children report a tingling sensation. Other symptoms include otalgia and a sensation of pressure in the ear.[symptoma.com]


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].

Immunoglobulin A Increased
  • Abstract In characterizing the immunochemical and biochemical nature of middle ear effusions (MEE) of chronic serous otitis media (SOM), we have previously shown that MEE contain all major immunoglobulin classes, increased levels of several lysosomal[ncbi.nlm.nih.gov]


  • Appropriate therapeutic strategies are designed, based on the severity of hearing loss, ranging from further testing and conservative treatment to surgery.[symptoma.com]
  • Ear tube placement should be considered in the treatment of long standing ear fluid. View Abstract An adenoidectomy has been shown to be effective in the treatment of serous otitis media.[entusa.com]
  • Serous Otitis Media: Treatment Treatment for acute serous otitis media includes treatment of the underlying conditions that have led to inflammation of the middle ear.[ic.steadyhealth.com]
  • Treatment Symptomatic relief and home care Most of otitis media infections are self-limiting and do not require any treatment.[ehealthhall.com]
  • All cases had adequate conservative medical and surgical treatment over a period of years for chronic serous otitis before mastoidectomy wa considered.[ncbi.nlm.nih.gov]


  • […] adequate treatment Tympanosclerosis Scarring of the tympanic membrane due to recurrent ear infections or otitis media with effusion May be asymptomatic or lead to conductive hearing loss White calcified plaques in the tympanic membrane seen on otoscopy Prognosis[amboss.com]
  • Intratemporal complications include: Petrositis Facial paralysis [ 17 ] Labyrinthitis Intracranial complications include: Lateral sinus thrombophlebitis Meningitis Intracranial abscess Sequelae include: Hearing loss Tympanosclerosis Prognosis [ 2 ] Prognosis[patient.info]
  • Prognosis Otitis media with effusion (OME) is the leading cause of hearing loss in children.[emedicine.medscape.com]
  • Inclusion of steroids in the drops improves prognosis. (Roland et al. 2003) Uncommon treatments: Steroids -- oral, nasal and injected steroids are occasionally used but their use is presently controversial.[dizziness-and-balance.com]


  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • OM is the general term that is used for the infection regardless of the etiology. There are different types of OM depending on the presenting signs and symptoms. Figure 1 shows what happen to the ear with an otitis media [1, 2].[ehealthhall.com]
  • Chronic suppurative otitis media Definition : persistent drainage from the middle ear through a perforated tympanic membrane lasting 6–12 weeks Epidemiology : most common in children and adolescents 15 years old Etiology : bacterial infection following[amboss.com]
  • The etiologies of the rest of the cases were acute sinusitis, gastroenteritis, parvovirus, serous otitis media, or influenza.[medical-dictionary.thefreedictionary.com]
  • Figure showing the areas lined by respiratory type of epithelium Etiology: 1. In many children otitis media with effusion is preceded by an episode of acute otitis media. This is common in children who is more prone for upper respiratory infections.[drtbalu.co.in]


  • Chronic suppurative otitis media Definition : persistent drainage from the middle ear through a perforated tympanic membrane lasting 6–12 weeks Epidemiology : most common in children and adolescents 15 years old Etiology : bacterial infection following[amboss.com]
  • Environmental factors Besides the actual pathogens, environmental factors have been shown in numerous epidemiologic studies to be strongly associated with increased prevalence of otitis media with effusion.[emedicine.medscape.com]
  • Clinical epidemiology of otitis media. Pediatr Infect Dis J. 2000;19(5 suppl):S31–S36. 10. Shekelle PG, Takata G, Newberry SJ, et al. Management of acute otitis media: update. Evid Rep Technol Assess (Full Rep). 2010;(198):1–426. 11.[aafp.org]
  • Epidemiology [ 1 ] In Britain, 0.9% of children and 0.5% of adults have CSOM, with no difference between the sexes.[patient.info]
  • Army: The Aeromedical Epidemiological Data Repository (AEDR) catalogs all Army flight physicals since 1960. There have been approximately 160,000 individual aircrew entered in this database.[asams.org]
Sex distribution
Age distribution


  • […] persistent drainage from the middle ear through a perforated tympanic membrane lasting 6–12 weeks Epidemiology : most common in children and adolescents 15 years old Etiology : bacterial infection following perforation of the tympanic membrane due to Pathophysiology[amboss.com]
  • Historically, the pathophysiology of OM has always been linked with abnormalities of ET function. As previously reviewed, the ET performs the three classic functions of aeration, clearance, and protection of the middle ear.[asams.org]
  • Pathophysiology Otitis media with effusion (OME) can occur during the resolution of acute otitis media (AOM) once the acute inflammation has resolved.[emedicine.medscape.com]


  • View Abstract Ear tubes have been shown to be effective in the prevention of recurrent acute otitis media. In many studies, their effectiveness exceeded prophylactic antibiotics.[entusa.com]
  • Permanent Perforation of the TM Large Perforation, Conductive Hearing Loss, Risks with Chronic Otitis Media Cholesteatoma, Ear Polyps, Tx Goals of Chronic Otitis Media Stop Otorrhea, Heal TM, Kill infection, Prevent Fungal infections and recurrence.[quizlet.com]
  • Surgery for chronic serous otitis media helps in dealing with infection and prevents potential complications (e.g. hearing loss). Myringotomy removes the accumulated fluid from the middle ear.[ic.steadyhealth.com]
  • Be attentive to a runny nose and prevent otitis media Prevention and treatment There is little scientific evidence that any specific measures are able to prevent otitis media.[hear-the-world.com]
  • Removing the adenoids can also help treat or prevent OME in some children. When adenoids become enlarged they can block ear drainage.[healthline.com]



  1. American Academy of Family Physicians; American Academy of Otolaryngology-Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004;113(5):1412-1429.
  2. Qureishi A, Lee Y, Belfield K, Birchall JP, Daniel M. Update on otitis media – prevention and treatment. Infect Drug Resist. 2014;7:15-24.
  3. Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc11.
  4. van Zon A, van der Heijden GJ, van Dongen TM, Burton MJ, Schilder AG. Antibiotics for otitis media with effusion in children [review] Cochrane Database Syst Rev. 2012;9: CD009163.
  5. Finkelstein Y, Ophir D, Talmi YP, Shabtai A, Strauss M, Zohar Y. Adult onset otitis media with effusion. Arch Otolaryngol Head Neck Surg. 1994;120(5):517–527.

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Last updated: 2019-07-11 20:24