Serous otitis media is a term which is used to describe a collection of fluid in the middle ear. This may be a recent onset (acute) or may be long standing (chronic).
Serous otitis media is the most common cause of hearing loss in children. Fortunately, the hearing loss associated with this condition usually is not permanent. Proper treatment restores the hearing to a normal level and prevents secondary complications, which can give rise to a more serious problem.
In serous otitis media, the external and inner ear and hearing nerve are normal. The problem stems from inadequate function of the Eustachian tube. The tube becomes blocked and does not allow air to fill the middle ear space. Subsequently, fluid (called serous fluid) forms from the middle ear lining and collects in the space (fig. 2). The presence of this serous fluid limits or “dampens” the vibration of the eardrum and causes a mild to moderate hearing impairment. This fluid makes the ear more susceptible to recurrent ear infections in many children. The trapped fluid is an ideal place for bacteria to grow and reproduce rapidly. Therefore, bacteria entering the middle ear space easily cause a purulent infection; the pus produced then exerts pressure on the eardrum with resultant pain (earache).
However, serous otitis media may be present without recurrent ear infections and a mild hearing loss may be the only sign of its presence.
Acute serous otitis media is usually the result of blockage of the eustachian tube from an upper respiratory infection or an attack of nasal allergy. In the presence of bacteria this fluid may become infected leading to an acute suppurative otitis media (infected or abscessed middle ear).
When infection does not develop the fluid remains in the middle ear until the eustachian tube again begins to function properly, at which time the fluid is absorbed or drains down the tube into the back of the throat.
Chronic serous otitis media may result from long standing eustachian tube blockage or from a thickening of the fluids so that it cannot be absorbed or drained down the tube. This chronic condition is usually associated with a hearing impairment. There may be recurrent ear pain, especially when the individual catches a cold. Serous otitis may persist for many years without producing any permanent damage to the middle ear mechanism. Presence of fluid in the middle ear, however, makes it very susceptible to recurrent acute infections. These recurrent infections may result in middle ear damage.
Abnormal patency of the eustachian tube is a condition occurring primarily in adults, in which the eustachian tube remains “open” for a prolonged period. This abnormality may produce many distressing symptoms such as ear fullness and blockage, a hollow feeling in the ear, hearing one’s own breathing and voice reverberation in the ear. It does not produce a hearing impairment although most patients will feel that they cannot hear as well in that ear.
The exact cause of an abnormally patent eustachian tube is often difficult to determine. At times it develops following a loss in weight or may develop during pregnancy. It may also occur while taking oral contraceptives or other hormones.
Treatment of this harmless condition is often difficult. Medical or surgical treatment is often directed towards causing mechanical obstruction of the eustachian tube or creating a less functional eustachian tube.
Chronic serous mastoiditis and idiopathic hemotympanm are uncommon conditions which have the same symptoms as chronic serous otitis media. They differ in that the middle ear fluid continues to form, either draining out the ventilation tube or blocking it completely so that the tube may become dislodged shortly after surgery. This persistent fluid formation is due to changes in the mucous membrane of the middle ear and mastoid.
In both of the above conditions, mastoid surgery may be necessary to control the problem and reestablish a normal middle ear mechanism.
Palatal myoclonus is a rare condition in which the muscles of the palate (back of the mouth) twitch rhythmically many times a minute. The cause of this harmless muscle spasm is unknown. Often it is triggered with eating some foods or drinking hot or cold liquids.
The patient may experience a rhythmic clicking or snapping sound in the ear as the eustachian tube opens and closes. On occasion, this snapping sound is caused by a simultaneous spasm of a muscle in the middle ear attached to the ear bones.
A muscle relaxant is often effective in controlling the symptoms. When they persist and if they continue to pose a problem for the patient, surgery is sometimes recommended. Cutting the muscle in the middle ear usually relieves the symptoms.
If surgical treatment is necessary, it is performed under local anesthesia through the ear canal. Hospitalization is necessary for one night following surgery, and the patient may return to his usual activities in several days.
Function of the Normal Ear
The ear is divided into three parts:
Each part performs an important function in the process of hearing.
The external ear and the middle ear conduct and transform sound; the inner ear receives it. When there is some problem in the external or middle ear, a conductive hearing impairment occurs. When the trouble lies in the inner ear, a sensori-neural or hair cell loss is the result. Difficulty in both the middle and inner ear results in a mixed hearing loss (i.e. conductive and a sensori-neural impairment).
Hearing impairment is a complex handicap. The task of adjusting to one’s handicap can be eased by remembering a few simple rules.
Whatever the type of hearing impairment, it is important to follow a planned program of “learning to use the hearing aid.” The ease or difficulty of hearing will vary depending on the loudness of background noises, the distance of the listener from the source of the sounds, the clarity of speech or of music, and the lighting (which may enhance or may interfere with lipreading). Practice exercises will help to prepare the wearer to use his hearing aid in a variety of different situations. Recommendations for learning to use a hearing aid for maximum benefit are described in the following paragraphs.
You may have certain communications that cannot be solved by the use of a hearing aid or by speech reading. These problems may involve the use of the telephone, radio, and television, and the inability to hear the door chime, telephone bell, and alarm clock.
Special instruments have been developed to solve these problems. They are listed in journals such as Shhh and Voice.
1. A complete audiologic/otologic examination is necessary to determine what type of hearing impairment is present, its probable cause and recommended treatment.
2. Hearing is a natural and a normal way to understand speech. If your hearing can be improved by medical or by surgical means, or through the use of a hearing aid, this should be done.
3. Whatever the type of treatment carried out, rehabilitation is essential if you are to gain maximum benefits from treatment.
4. Be determined to master speech reading, make a hobby of it. It will help in every conversation.
5. Make every effort to relax. Do not strain either to hear or to see speech. Strain causes tension and makes lip reading much more difficult. A combination of seeing and hearing, under relaxed conditions, enables persons with impaired hearing to hear most speakers quite well.
6. Do not expect to understand every word in a conversation, but follow along with the speaker. As you become familiar with the speech, key words will emerge and you will be able to understand the complete thought.
7. Try to stage-manage the situation to your advantage. Lighting is important. Avoid facing a bright light and avoid having a shadow on the speaker’s face. Six feet is an ideal separation from the speaker; from this distance his lip movements, facial expressions and gestures can be readily observed.
8. Maintain an active interest in people and events. Keep abreast of national affairs and events in your community and intimate social circles. You will be able to follow discussions more easily.
9. Remember that conversation is a two-way affair. Do not monopolize the conversation in an attempt to direct and control it. On the other hand, do not let it pass by without participating. Take an active and interested part whenever possible.
10. Be particular about your speech. A hearing impairment of long duration may bring changes in volume as well as in articulation and voice quality. These changes must be prevented when possible and corrected where indicated. A pleasant, well-modulated voice is a great asset.
11. A friendly, sympathetic interest in other people and in their problems can do much to smooth one’s own path.
12. The education of the public is your responsibility and ours alike. You cannot help others to understand your problem if you conceal it from them. Do not hide the fact that you wear a hearing aid, or that you depend on speech reading to understand conversation. By letting others know about your problem, you can make communications easier for you. It is only through mutual acceptance and understanding of the problems of persons with impaired hearing that the “outsider” can be expected to adjust to needs of the speech reader. Without this understanding the “outsider” may unintentionally add to the problems of the speech reader.
13. Always keep in mind that the success of your auditory rehabilitation is largely dependent on you, your attitude and your acceptance of the problem.
14. Try to find a quiet place to talk. Cutting down on background noise will make it easier to understand the speaker.
15. Ask people to repeat or rephrase things that are not clear. Pretending to understand when you do not will only cause problems later.