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1、SecretoryOtitisMedia (SOM)#Definition:Secretoryotitismedia(SOM)isthenon-suppurativeotitismediawhichcharacteristicsarenoninfectedfluidinmeddleearandconductivehearingloss. #variousnames:serousotitismedia,otitismediacatarrh,middleeareffusion,andifthefluidisverysticky,call
2、ed"glueear".#Acuteotitismedia(AOM):aninflammationofthemiddleearthatpresentswitharapidonsetofsignsandsymptoms,suchaspain,fever,irritability,anorexia,orvomiting. #Chronicotitismedia:middleearfluidthathasbeenpresentforthreemonthsorlonger.Classification#Changesinthemiddlee
3、arintheearlystagesofacutesuppurativeotitismediaaresimilartothoseinsecretoryotitismedia. #Somecasesofsecretoryotitismediawillgoontobacterialinfectionandsuppuration. #otiticbarotrauma.InadditionEtiologyandPathologyAccumulationofserousfluidinthemiddleeariscommonlyseenwit
4、hacuteviralupperrespiratoryinfection, morefrequentlyin childrenthaninadults. Secondarybacterial infectionfrequently develops.fluid1.ObstructionoftheeustachiantubeappearstobethemostimportantantecedenteventassociatedwithSOM.obstruction2.Virus:infectioninthenasopharynxwith
5、subsequentinflammationoftheorificeandmucosaoftheeustachiantube. 3.Bacteria:Fourbacteria,ie,Streptococcuspneumoniae,Haemophilusinfluenzae,Moraxellacatarrhalis,andStreptococcuspyogenes,areresponsibleforthepreponderanceofepisodesofSOMinpersonsolderthan6weeks.4.Immunologic
6、alactivitymayplayasignificantroleinthefrequencyofSOManditsoutcome.ClinicalFeaturesSymptoms:1.hearinglose:Asensationofearblockageispresent.Thepatient'sownvoicemaysoundloudertohim.2.pain:Theremaybediscomfortorpainintheear.3.tinnitus:Itmaybelowfrequencysoundandcanbechangew
7、iththeheadposition.OnExamination.Thesignsobservedarethoseduetoacuteupperrespiratoryinfection:fever,injectedpharynx,anddischargefromthenose.Theearcanalisnormal.Theearliestchange Eardrumisretractedtowardthemiddleear: Theanteriorandposteriormalleolarfoldsandtheshortproces
8、sandhandleofthemalleusbecomeveryprominent. Similarlytheconeoflightmayappearmoreprominent. Themobilityofthetymp
