Serous Otitis: Symptoms, Causes, Treatments

Serous or seromucosal otitis is a chronic inflammation of the middle ear, accompanied by the presence of fluid behind the eardrum. It is responsible for hearing loss. If it usually heals spontaneously, treatments are sometimes necessary, especially if the disease causes a delay in language acquisition in children.

What is serous or seromucosal otitis?

Serous or seromucosal otitis (OSM) corresponds to an inflammation of the mucosa of the middle ear responsible for effusion in the cavities of the middle ear for more than 3 months.

Serous otitis is devoid of acute symptoms and does not lead to perforation of the eardrum: we are talking about otitis with a closed eardrum. The patient does not have a fever or pain in the ear. The main clinical sign is hearing loss. In this regard, serous otitis is the first cause of defective hearing.

Serous otitis is a common condition, especially in children, affecting nearly 50% of children. The average age is 5 years, and it is most often bilateral in 85% of cases (affecting both ears).

Chronicity is rare and must be confirmed by repeated examinations because the majority of effusions resolve themselves spontaneously. However, treatment may be necessary because of the hearing loss that otitis generates and which can lead to a delay in learning and language acquisition in children.

What causes serous otitis?

Obstruction of the Eustachian tube

The pressure in the middle ear regains its balance 3 to 4 times per minute, thanks to the opening of the Eustachian tube during swallowing or yawning.

In the case of serous otitis, the Eustachian tube becomes blocked causing a loss of pressure in the middle ear. This results in the accumulation of a liquid in the eardrum case, reducing the elasticity of the eardrum.

Risk factors for serous otitis

Serous otitis can develop as a result of acute otitis media that has not been completely cured. However, other factors of obstruction of the Eustachian tube are involved:

  • allergies;
  • enlarged adenoids ;
  • an otolaryngological (ENT) abnormality, such as cleft palate (called “cleft lip”) or only of the soft palate (soft palate) or uvula ;
  • a tumour (tumor of the cavum (undifferentiated cancer, lymphoma, rhabdomyosarcoma …), infratemporal fossa or petrous apex);
  • trisomy 21 ;
  • an immune deficiency (HIV infection, diabetes, taking drugs with immunosuppressive effects…);
  • ciliary disease.

How to recognize serous otitis?

Serous otitis often goes unnoticed because it does not cause acute symptoms such as fever or pain in the ear. Hearing loss is the first warning sign. It can be highlighted in the absence of symptoms, as part of the follow-up of repeated acute otitis media.

Symptoms can last for several months, but the disease usually resolves spontaneously. Treatment can be put in place especially if the hearing loss alters the quality of life, learning, or academic results in the child.  

Symptoms of serous otitis in children and adults

  • Hearing loss;
  • a foreign body sensation in the ear or a full ear
  • balance disorders;
  •  dizziness
  • an amplified perception of his own voice.

Recognizing serous otitis in infants and toddlers

  • Delay or stagnation in language acquisition;
  • difficulties in articulating;
  • a lack of reaction to noise.

Recognizing serous otitis in school-age children

  • Persistent delay in language acquisition;
  • learning and comprehension difficulties;
  • errors and a drop in academic performance;
  • attention disorder or hyperactivity;
  • agitated and noisy behavior or on the contrary very calm and withdrawn;
  • a lack of reaction to the noise or the call of his name.

What are the treatments for serous otitis?

Serous or seromucosal otitis usually heals without treatment. Medications may be needed to treat the nasopharyngeal infection. More rarely, surgery is necessary, it consists of placement of tympanic aerators, and sometimes an ablation of vegetations may be associated.

Elimination of risk factors

In the majority of cases, the disappearance of otitis essentially involves the elimination of risk factors:

  • Nasopharyngeal disinfection through nose washes;
  • management of gastroesophageal reflux disease (GERD) or possible allergies;
  • treatment of an underlying ENT malformation;
  • treatment of iron anemia or any other nutritional deficiency;
  • the removal of inhaled pollutants (indoor spray, pollution, dust, etc.);
  • avoidance of passive smoking.

Treatment that is sometimes necessary

There are situations in which treatment must be put in place. This is the case when serous otitis:

  • Causes hearing loss affecting language acquisition in children;
  • is complicated by superinfection such as acute otitis media or eardrum retraction;
  • recurrence regularly;
  • becomes chronic (e.g. in case of underlying ENT malformation).

Drug treatment

Medications can relieve symptoms in the short term. They include:

  • Washing and decluttering of the nasal cavity with decongestants and sometimes antihistamines;
  • taking oral anti-inflammatory drugs NSAIDs and sometimes corticosteroids.  

Antibiotics are ineffective in cases of serous otitis and expose to a risk of side effects and the development of antibiotic resistance.

Tubal insufflation

Methods of tubal balloon insufflation or self-insufflation are effective on seromucosal otitis of children over 4 years of age able to use this technique. They can be explained and supplemented by tubal rehabilitation by a speech therapist.

Surgical treatment: tympanic drains and removal of vegetation

Sometimes surgical treatment may be necessary. It consists of the installation of tympanic drains or aerators also called yoyos or diabolos. This system is placed in the membrane of the eardrum and allows the ventilation of the eardrum (middle ear).

This device makes it possible to regain normal hearing, but also to avoid chronic and recurrent otitis media. Tympanic aerators are either silicone or titanium. They have a coil shape (they are then eliminated spontaneously in 4 to 18 months) or T (in this case they take longer to be eliminated).

An associated adenoidectomy (removal of vegetations) increases the beneficial effect of tympanic aerators in children over 4 years of age.

Image Credits: Image by stefamerpik on Freepik

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