[Clinical importance of tympanometry in the diagnosis of chronic secretory otitis]

Secretory otitis media is defined as a fluid in the middle ear without signs or symptoms of infection. As the aetiology and pathogenesis of the disease are unknown, and as it affects children aged from 3 to 12 years, treatment procedures proposed for management of secretory otitis media, are not uniform. Some authors [1, 4, 6] consider that functional or mechanical obstructions of the Eustachian tube could provoke secretory otitis. The purpose of the treatment is to remove exudate from the middle ear and appropriately ventilate it for a longer period. That could instantly normalize the hearing and exclude the appearance of late complications of secretory otitis. Although the disease could heal spontaneously, the treatment should be performed immediately for preventing sequelae of secretory otitis. The aim of the study was to evaluate possible aetiologic factors of secretory otitis in our population, and to evaluate results of lympanometry in children with exudate in the middle ear. There were 65 children, aged from 3 to 12 years (Table 1), who complained of deafness and were examined at the ORL Department in Banja Luka. The clinical examination revealed the integrity and color of tympanic membrane, scars, adhesions and atrophic areas. Audiometry and tympanometry had been performed in addition. Patients who proved to have exudate in the middle ear received nasal decongestants and mucolitics during three months, and were evaluated every three weeks by audiometry and tympanometry. Pathologic findings in the nose and epipharynx were the most common findings: enlarged adenoids in 38 (58%) patients, hypetrophic rhinitis in 15 (23%) and allergic rhinitis in 5 (8%) patients. Frequent relapses of middle ear infection in the first three years of life were found in 26 (40%) patients and early first attacks in the first year of life in 15 (23%) patients (Table 2). Premature onset (15%) and allergy (21%) had also been frequently found. Results of tympanometry and audiometry are shown in Table 3. Exudate in the middle ear and type B tympanogram were found in 86 ears, while in other patients dysfunction of the Eustachian tube and type C1 and C2 tympanograms were found. After 6 weeks the exudate disappeared in 16 ears and tympanogram converted in type A and type C2, while the initially found C1 tympanogram was transformed in type A in 5 of 13 ears. After 12 weeks the tympanogram type B was found in 46 ears, while in 40 ears (47%) the tympanogram was changed in type A and type C2. After 6 and 12 weeks of therapy tympanometric types were statistically examined by chi 2 test. We have found a significant difference in tympanometric types and prevalence of type A and C1 tympanograms. Paracentesis and insertion of ventilating tubes were done in 46 ears with the remaining exudate. We have found mucous exudate in 35 (76%) ears associated with retraction and scars of tympanic membrane (Table 4), what indicated that the longer duration of mucous exudate caused degenerative changes in the middle ear. Serous exudate, found in 9 ears (24%), did not affect the color and integrity of the tympanic membrane. Sensitivity of tympanometry in detection of exudate in the middle ear was 96%. Secretory otitis media is a frequent disease in childhood, that could cause functional and morphological sequelae in the middle ear. As for now, there is no unique concept of diagnosis and treatment of the disease, and it is still a current problem. We suggest a three-month evaluation of tympanometric and audiometric patterns, repeated every three weeks, in children suspected of having exudate in the middle ear. There is a large trend of spontaneous disappearance of exudate in the middle ear and changing of tympanogram type. Such children should be evaluated over the period of one year, and if there is no relapse additional treatment should not be carried out. If exudate in the middle ear persists for three months and type of the tympanogram is unchanged, myringotomy and insert