Acta Oto-Laryngologica
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Chronic Secretory Otitis Media O. K. Haugeto, H. H. Elverland, K. E. Schrøder & I. W. S. Mair To cite this article: O. K. Haugeto, H. H. Elverland, K. E. Schrøder & I. W. S. Mair (1978) Chronic Secretory Otitis Media, Acta Oto-Laryngologica, 86:sup360, 192-194, DOI: 10.3109/00016487809123514 To link to this article: http://dx.doi.org/10.3109/00016487809123514
Published online: 08 Jul 2009.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [UNSW Library]
Date: 24 April 2016, At: 04:27
Acta Otolaryngol, Suppl. 360: 192-194, 1979
CHRONIC SECRETORY OTITIS MEDlA
Downloaded by [UNSW Library] at 04:27 24 April 2016
0. K. Haugeto, H. H. Elverland, K. E. Schrsder and 1. W. S . Mair
been treated for ear disease, whilst the remaining 31 % had received one or more treatments prior to this date. The earliest date for the first treatment was 1963. None of the 166 new patients was admitted to hospital before 6 weeks had elapsed following out-patient diagnosis, and most had completed an unsuccessful course of medical therapy. Secretory otitis media has not been regarded as an indication for routine adenoidectomy, Chronic secretory otitis media denotes the this being performed on the basis of coincident persistence of non-purulent fluid in the middle chronical nasal obstruction and/or infection. ear cleft. The condition is very common in The primary otological procedure was ranpaediatric ototologic practice and, while the domized for a proportion of the patients first degree of hearing loss may be extremely vari- seen in 1972. 34.8% of the group treated by able (Cohen & Sade, 1972; Sade, 1974), there myringotomy alone required a repeat proceis evidence that poor language development dure within 3 months, while the corresponding and scholastic achievement may be a sequel figure for those receiving tympanostomy tubes (Kaplan et al., 1973; Lewis, 1976). It is also initially was only 7.6%. This protocol was probable that secretory otitis media represents therefore terminated, and transmyringeal a stage in a continuum of middle ear patho- aeration performed as the routine procedure. logy, which may progress to atelectasis and Control otoscopy was repeated at short interchronic suppurative otitis (Jordan, 1963; vals during the first 6 months after the initial Dawes, 1970; Paparella, 1976). This report procedure, and many of the patients have been presents the treatment results for a group of followed at regular intervals thereafter. All patients with chronic secretory otitis media, were requested to attend the department in the minimum observation period being 5 1977, and 2 12 (87.6 %) have presented for folyears. low-up assessment. A total of 668 otological procedures has been performed, 99 patients requiring only one MATERIAL AND RESULTS treatment, whilst insertion of aeration tubes The age and sex distribution of the 242 pa- has been necessary on twelve occasions for tients admitted to the Department of Otorhino- one patient. Purulent otorrhoea has occurred a laryngology in 1972 for treatment of secretory total of 81 times in 57 patients following introotitis media are shown in Fig. 1. The mean duction of tympanosotomy tubes. 7.4% of age was 7 years, and no patient was older than these patients subsequently developed chronic 19. 166 of these patients had not previously suppurative otitis media, while this complica-
Abstract. 212 of 242 patients (88%’) treated for chronic secretory otitis media in 1972 were reexamined 5 years later. A total of 668 otological procedures has been performed, 99 patients being treated only once, while one patient received 12 procedures. The pure tone threshold was 20 dB or less in 88 %5 of the ears in 1977, whilst only 57% had a type A tympanogram. Normal otoscopy was found in 40.5% of the ears. persisting secretory otitis in 1 1 %, atelectasis in 2.8% and chronic suppurative otitis in 2.6%; the remaining 41.9% showed varying degrees of scarring and rnyringosclerosis.
A ( ‘ t o Otol(rr?ti,gol SiippI360
Chronic secretory otitis mudiu
Female
Age i n y e a r s
Downloaded by [UNSW Library] at 04:27 24 April 2016
Fig. I
tion occurred in only 1.2% of those without secretion following middle ear ventilation. The incidence of secretory otitis media showed a reduction from 86.2% in 1972 to 1 I . 1 % in 1977, whilst the numbers of atelectatic and chronic suppurative ears had both increased fourfold, to respectively 2.8 % and 2.6% of the total. Only 40.6% of ears were otoscopically normal, whilst scarring, retraction and varying degrees of myringosclerosis were found in 42.9%. The proportion of ears with a pure tone threshold of 20 dB or better increased from 49.7 to 87.7% over the 5-year period. Impedance audiometry was performed in the majority of patients in 1977, the acoustic reflex being elicitable in 69.5%, while 57% of the ars had a middle ear pressure of less than - 100 mmH,O.
DISCUSSION The prognosis of secretory otitis media would appear to vary widely according to different reports in the literature. A success rate of 96.9% following adenoidectomy and myringotomy has been reported, although no hearing evaluation was performed, and recurrence of middle ear fluid within one month was regarded as a new disease (Gottschalk, 1972). Our experiences following a randomized comparison of myringotomy and tube insertion would again indicate that myringotomy alone is not an adequate short-term treatment for 13-783856
193
this condition. The repeated demonstration of pronounced morphological changes in the mucosal lining from ears with chronic secretory otitis (Tos & Bak-Pedersen, 1972; Sade, 1974) would also negate the “new disease” hypothesis. Since hearing thresholds in secretory otitis may show considerable variation (Kapur, 1964; Sade, 1974), it is not surprising that the hearing status following treatment also differs widely. normal hearing having been reported in only 50% of cases (Watson, 19691, whilst 20-25 dB thresholds have been equalled ot bettered in 79-97 % in different series (Gundersen & Tonning, 1976; Tos & Paulsen, 1976). Our figure of 87.7% is almost exactly the mean of the two latter Scandinavian reports. Tympanometry is currently recommended as a more sensitive screening technique for the diagnosis of middle ear disease (Brooks, 1969; Renvall & Holmquist, 1976). Only 57% of our patients had a type A tympanogram, which can be compared with the 67 % reported at 5-8 years by Tos & Poulsen (1976). A type A tympanogram was obtained in 80% of the otoscopically normal ears in 1977, and in 54% of those with scarring and myringosclerosis. The percentage of otoscopically normal ears increased fourfold during the observation period, while the incidence of secretory otitis was reduced from 86 to 11 %. It is disturbing, however, that persistent or serious pathology was found in 16.5% of ears after an observation period of 5-14 years. These results must be compared with the known age-related incidence of secretory otitis (Bluestone & Shurin, 1974; Oppenheimer, 1979, and with recent reports that the long-term functional results are not influenced by the use of tympanostomy tubes (Kilby et al., 1972; Brown et al., 1978). The conflicting results in the literature may be the consequence of accidental case selection, or hitherto unrecognised geographical variations in secretory otitis disease patterns. There is at present no convincing evidence for the long-term superiority of any one treatment modality. A ( I U O l o l r r ~vtlgol Slippl360
194
0. K . Hcrirgeto et ul. ZUSAMMENFASSUNG
rend die restierenden Ohren, 42.952, Narben unterschiedlichen Grades und Myringosklerosis zeigten.
Downloaded by [UNSW Library] at 04:27 24 April 2016
212 von 242 Patienten (88%,),die an chronischer seroser Otitis media im Jahre 1972 litten, wurden fiinf Jahre spaA list of literature references may be obtained from the ter neu untersucht. lnsgesarnt 668 operative Eingriffe sind authors on request. gemacht worden, 99 Patienten wurden nur einmal operiert, wahren ein Patient 12 Operationen durchmachen mul3te. Das Audiogramm was besser als 20 dB in 88% der Ohren bei der Untersuchung 1977, wahrend nur 57% einen Typ A Tyrnpanograrnm hatten. Normale Otoskopie wurde in 40,s 5 7 der Ohren gefunden, bestehende sekretorische Otitis media in I 1 75. atelektatisches Ohr in 2 , 8 7 ~ . und chronische suppurative Otitis media in 2,6’%, wah-
ISSN: 0001-6489 (Print) 1651-2251 (Online) Journal homepage: http://www.tandfonline.com/loi/ioto20
Chronic Secretory Otitis Media O. K. Haugeto, H. H. Elverland, K. E. Schrøder & I. W. S. Mair To cite this article: O. K. Haugeto, H. H. Elverland, K. E. Schrøder & I. W. S. Mair (1978) Chronic Secretory Otitis Media, Acta Oto-Laryngologica, 86:sup360, 192-194, DOI: 10.3109/00016487809123514 To link to this article: http://dx.doi.org/10.3109/00016487809123514
Published online: 08 Jul 2009.
Submit your article to this journal
Article views: 4
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ioto20 Download by: [UNSW Library]
Date: 24 April 2016, At: 04:27
Acta Otolaryngol, Suppl. 360: 192-194, 1979
CHRONIC SECRETORY OTITIS MEDlA
Downloaded by [UNSW Library] at 04:27 24 April 2016
0. K. Haugeto, H. H. Elverland, K. E. Schrsder and 1. W. S . Mair
been treated for ear disease, whilst the remaining 31 % had received one or more treatments prior to this date. The earliest date for the first treatment was 1963. None of the 166 new patients was admitted to hospital before 6 weeks had elapsed following out-patient diagnosis, and most had completed an unsuccessful course of medical therapy. Secretory otitis media has not been regarded as an indication for routine adenoidectomy, Chronic secretory otitis media denotes the this being performed on the basis of coincident persistence of non-purulent fluid in the middle chronical nasal obstruction and/or infection. ear cleft. The condition is very common in The primary otological procedure was ranpaediatric ototologic practice and, while the domized for a proportion of the patients first degree of hearing loss may be extremely vari- seen in 1972. 34.8% of the group treated by able (Cohen & Sade, 1972; Sade, 1974), there myringotomy alone required a repeat proceis evidence that poor language development dure within 3 months, while the corresponding and scholastic achievement may be a sequel figure for those receiving tympanostomy tubes (Kaplan et al., 1973; Lewis, 1976). It is also initially was only 7.6%. This protocol was probable that secretory otitis media represents therefore terminated, and transmyringeal a stage in a continuum of middle ear patho- aeration performed as the routine procedure. logy, which may progress to atelectasis and Control otoscopy was repeated at short interchronic suppurative otitis (Jordan, 1963; vals during the first 6 months after the initial Dawes, 1970; Paparella, 1976). This report procedure, and many of the patients have been presents the treatment results for a group of followed at regular intervals thereafter. All patients with chronic secretory otitis media, were requested to attend the department in the minimum observation period being 5 1977, and 2 12 (87.6 %) have presented for folyears. low-up assessment. A total of 668 otological procedures has been performed, 99 patients requiring only one MATERIAL AND RESULTS treatment, whilst insertion of aeration tubes The age and sex distribution of the 242 pa- has been necessary on twelve occasions for tients admitted to the Department of Otorhino- one patient. Purulent otorrhoea has occurred a laryngology in 1972 for treatment of secretory total of 81 times in 57 patients following introotitis media are shown in Fig. 1. The mean duction of tympanosotomy tubes. 7.4% of age was 7 years, and no patient was older than these patients subsequently developed chronic 19. 166 of these patients had not previously suppurative otitis media, while this complica-
Abstract. 212 of 242 patients (88%’) treated for chronic secretory otitis media in 1972 were reexamined 5 years later. A total of 668 otological procedures has been performed, 99 patients being treated only once, while one patient received 12 procedures. The pure tone threshold was 20 dB or less in 88 %5 of the ears in 1977, whilst only 57% had a type A tympanogram. Normal otoscopy was found in 40.5% of the ears. persisting secretory otitis in 1 1 %, atelectasis in 2.8% and chronic suppurative otitis in 2.6%; the remaining 41.9% showed varying degrees of scarring and rnyringosclerosis.
A ( ‘ t o Otol(rr?ti,gol SiippI360
Chronic secretory otitis mudiu
Female
Age i n y e a r s
Downloaded by [UNSW Library] at 04:27 24 April 2016
Fig. I
tion occurred in only 1.2% of those without secretion following middle ear ventilation. The incidence of secretory otitis media showed a reduction from 86.2% in 1972 to 1 I . 1 % in 1977, whilst the numbers of atelectatic and chronic suppurative ears had both increased fourfold, to respectively 2.8 % and 2.6% of the total. Only 40.6% of ears were otoscopically normal, whilst scarring, retraction and varying degrees of myringosclerosis were found in 42.9%. The proportion of ears with a pure tone threshold of 20 dB or better increased from 49.7 to 87.7% over the 5-year period. Impedance audiometry was performed in the majority of patients in 1977, the acoustic reflex being elicitable in 69.5%, while 57% of the ars had a middle ear pressure of less than - 100 mmH,O.
DISCUSSION The prognosis of secretory otitis media would appear to vary widely according to different reports in the literature. A success rate of 96.9% following adenoidectomy and myringotomy has been reported, although no hearing evaluation was performed, and recurrence of middle ear fluid within one month was regarded as a new disease (Gottschalk, 1972). Our experiences following a randomized comparison of myringotomy and tube insertion would again indicate that myringotomy alone is not an adequate short-term treatment for 13-783856
193
this condition. The repeated demonstration of pronounced morphological changes in the mucosal lining from ears with chronic secretory otitis (Tos & Bak-Pedersen, 1972; Sade, 1974) would also negate the “new disease” hypothesis. Since hearing thresholds in secretory otitis may show considerable variation (Kapur, 1964; Sade, 1974), it is not surprising that the hearing status following treatment also differs widely. normal hearing having been reported in only 50% of cases (Watson, 19691, whilst 20-25 dB thresholds have been equalled ot bettered in 79-97 % in different series (Gundersen & Tonning, 1976; Tos & Paulsen, 1976). Our figure of 87.7% is almost exactly the mean of the two latter Scandinavian reports. Tympanometry is currently recommended as a more sensitive screening technique for the diagnosis of middle ear disease (Brooks, 1969; Renvall & Holmquist, 1976). Only 57% of our patients had a type A tympanogram, which can be compared with the 67 % reported at 5-8 years by Tos & Poulsen (1976). A type A tympanogram was obtained in 80% of the otoscopically normal ears in 1977, and in 54% of those with scarring and myringosclerosis. The percentage of otoscopically normal ears increased fourfold during the observation period, while the incidence of secretory otitis was reduced from 86 to 11 %. It is disturbing, however, that persistent or serious pathology was found in 16.5% of ears after an observation period of 5-14 years. These results must be compared with the known age-related incidence of secretory otitis (Bluestone & Shurin, 1974; Oppenheimer, 1979, and with recent reports that the long-term functional results are not influenced by the use of tympanostomy tubes (Kilby et al., 1972; Brown et al., 1978). The conflicting results in the literature may be the consequence of accidental case selection, or hitherto unrecognised geographical variations in secretory otitis disease patterns. There is at present no convincing evidence for the long-term superiority of any one treatment modality. A ( I U O l o l r r ~vtlgol Slippl360
194
0. K . Hcrirgeto et ul. ZUSAMMENFASSUNG
rend die restierenden Ohren, 42.952, Narben unterschiedlichen Grades und Myringosklerosis zeigten.
Downloaded by [UNSW Library] at 04:27 24 April 2016
212 von 242 Patienten (88%,),die an chronischer seroser Otitis media im Jahre 1972 litten, wurden fiinf Jahre spaA list of literature references may be obtained from the ter neu untersucht. lnsgesarnt 668 operative Eingriffe sind authors on request. gemacht worden, 99 Patienten wurden nur einmal operiert, wahren ein Patient 12 Operationen durchmachen mul3te. Das Audiogramm was besser als 20 dB in 88% der Ohren bei der Untersuchung 1977, wahrend nur 57% einen Typ A Tyrnpanograrnm hatten. Normale Otoskopie wurde in 40,s 5 7 der Ohren gefunden, bestehende sekretorische Otitis media in I 1 75. atelektatisches Ohr in 2 , 8 7 ~ . und chronische suppurative Otitis media in 2,6’%, wah-
