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guidelines for Secretory Otitis Media-Secretory Otitis Media

guidelines for Secretory Otitis Media-Secretory Otitis Media
Secretory otitis media visit the compass to Secretory otitis media patients to the hospital often appear questions to answer, for example: Secretory otitis media hang what department number? Matters needing attention before examination of secretory otitis media? What do doctors usually ask? What examination should secretory otitis media do? What do you think of the examination results of secretory otitis media? Wait. The purpose of the guidelines is to facilitate the patients with secretory otitis media to seek medical treatment and solve the doubts of patients with secretory otitis media.
Typical symptom
Earache and hearing loss
Suggested visiting department
Otolaryngology
Best visit time
Hearing loss, mild earache, tinnitus, ear tightness and occlusion
Duration of visit
The general course of treatment is no more than 1 week
Frequency of follow-up visit/diagnosis and treatment cycle
2-4 weeks
Preparation before seeing a doctor
It is best to wash the outer ears with hydrogen peroxide first.
Common consultation contents
1. Describe the reason for seeing a doctor (when did you start and what's wrong?)
2. Have you been to the hospital, have you done those examinations, and what are the examination results?
Key inspection items
1. Air-inflated otoscopy or microscopy
Pneumatic otoscopy is convenient and easy, which is the main diagnostic method of secretory otitis media and the first choice for tympanic membrane examination in community. It can change the air pressure of the external auditory canal and observe the activity of the tympanic membrane. If tympanic membrane is foundMobility is reduced, accompanied by invagination of tympanic membrane, and the color changes from normal gray-white translucent to orange or amber, which can be diagnosed when gas-liquid plane or bubbles are seen. Compared with ordinary otoscope, pneumatic otoscope has higher sensitivity and specificity.
2. Acoustic immittance test
Acoustic immittance test is a fast and effective method of guest observation and listening to reflect the function of middle ear. Because it is difficult to judge the tympanic membrane and middle ear of children under 2 years old, acoustic immittance provides a convenient test. The tympanogram of acoustic immittance can be B-type and C-type. At the beginning, the Eustachian tube was dysfunctional or blocked, the gas in the middle ear was absorbed to form negative pressure, the tympanic membrane was invaginated, and the peak pressure point of tympanic pressure shifted to the negative pressure side, with C-shaped curve being more common. When the lesion progresses gradually, the tympanic membrane is more invaginated, tympanic effusion appears, the quality of sound transmission structure increases, which makes the acoustic immittance further increase, the tympanic stiffness increases, the activity of tympanic membrane and ossicular chain decreases, and the peak pressure point tends to be more negative. When the sound sequence weakens or does not change, it becomes a B-type diagram without peak.
3. Myringocentesis or myringotomy
Under the ear microscope or endoscope, puncture or incision is performed at the front and bottom of the tympanic membrane. If serous or mucous fluid flows out, the existence of secretory otitis media can be confirmed. It is an invasive diagnostic method, which can not only make a clear diagnosis, but also achieve the purpose of treatment.
4. Nasopharyngeal examination
In adult patients, nasopharynx and pharyngeal orifice of eustachian tube were observed directly with nasal endoscope or multifunctional fiberoptic nasopharyngoscope. The nasopharyngeal space-occupying lesions were excluded.
5. High resolution thin-slice CT of temporal bone
Unilateral intractable secretory otitis media is ineffective after treatment, so we should be alert to submucous nasopharyngeal carcinoma involving the parapharyngeal space and compressing the eustachian tube. If differential diagnosis is needed, or if space occupation in nasopharynx and parapharyngeal space needs to be excluded, high-resolution thin-layer CT of temporal bone can know the middle ear, and whether space occupation in parapharyngeal space can be observed when CT film is adjusted to soft tissue window. Enhanced scanning is required if necessary.
Diagnostic criteria
According to medical history and specialist examination, combined with tympanogram and acoustic reflex, ear microscope or endoscopy, tympanic membrane puncture or incision, etc., the diagnosis can be made clearly. Tympanic membrane puncture or myringotomy, under ear microscope or endoscope, puncture or incision at the front and bottom of tympanic membrane, if serous or mucous fluid flows out, the existence of secretory otitis media can be confirmed. It is an invasive diagnostic method, which can not only make a clear diagnosis, but also achieve the purpose of treatment.


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