Secretory Otitis Media - also called Otitis Media with Effusion, sometimes referred to as Glue Ear is a very common ear condition in children in which there is sterile collection of fluid in the middle ear of the child. The collection of fluid dampens the movement of the ear drum leading to sensation of ear blockage and loss of hearing. There are usually two peaks in a child's life- at 2 years and then at 5 years of age.

Secretory Otitis Media (SOM) must be distinguished from Acute Otitis Media (AOM, ASOM) which is usually an infective condition and there is accompanying ear pain, or Chronic Suppurative Otitis Media (CSOM) in which there is usually an accompanying ear discharge.

What Causes SOM?

The occurrence of SOM in very small children is linked to their poor/ immature immune status. A breastfed infant normally loses maternal antibodies by 18 months of age. At the age of 2 years the child is exposed to the outside environment and other children for the first time - play school, day care centres, parks etc. The small child picks up infections easily in these early days - this causes simple colds and sore throat which lead to compromise of Eustachian Tube function leading to accumulation of a fluid build up in the middle ear.

Two other causes are:

- Allergies - The Hygiene Hypothesis suggests that as we bring up our children in cleaner and more sterile environments we prevent them from developing a robust immune system. This also makes them more prone to allergies

- Adenoids- Among the commonest causes of SOM is an enlarged Adenoid Tissue - a kind of a Tonsil that sits in the back of the child's nose and causes nasal blockage as well as leading to blockage of the Eustachian Tube.

Pic - Courtesy - healthdirect.gov.au

Investigations

The child should be subjected to an Audiometry test (above 3 years of age) as well an Impedance Tympanometry to assess middle ear function.

How to Treat SOM?

SOM has traditionally been treated with a variety of medications which include Antibiotics, Decongestants, Anti Allergic medication, Nasal drops, Auto Inflation (in the older child) etc.

However, the condition is generally self limiting.

There is usually no role of Antibiotics in this condition since the fluid in the middle ear is sterile.

There is a role of Surgery - Either Myringotomy with Grommet insertion, or Adenoidectomy (Removal of the Adenoids) along with Myringotomy and Grommet insertion.

The indications for surgery must be clearly present.

For the sake of hearing loss a period of 12 weeks of treatment and observation is usually recommended before surgical intervention is contemplated.