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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 58
CHRONIC NON-SUPPURATIVE OTITIS MEDIA

This condition is characterized by the chronic accumulation of non-purulent
fluid in the middle ear cavity. It has been called exudative otitis media,
secretory otitis media, seromucinous otitis media and, more simply, glue
ear. These titles suggest that there is, as yet, no agreement as to the nature
of the fluid, or of its cause, while glue ear avoids any theory regarding the
aetiology and is merely descriptive of the high viscosity of the middle ear
contents.

AETIOLOGY. There is no universally agreed cause. Popular belief holds that
obstruction of the Eustachian tube results in absorption of air from the
middle ear and mastoid cells. This results in a passive congestion of the
lining mucosa. Doubt arises as to whether the fluid which is produced is a
transudate or an exudate, and it is possible that each theory is correct, each
resulting in a different type of fluid. The fact that the condition is commonly
bilateral points to a central cause, and the fact that glue ear is most commonly
found in children suggests that the central cause is adenoids. This, however,
cannot be the whole explanation because a considerable proportion of cases
occurs in children in whom either the adenoids have been previously removed
or the adenoid pad found at operation is quite small. In an acute otitis media
in a child with a pad of adenoids the mucopus in the middle ear eventually
drains into the nasopharynx through the Eustachian tube. In glue ear the
middle ear fluid, whether it be thin or thick, does not drain, and this implies
a dysfunction of the tube. Further confirmation of this theory arises from
the fact that inflation of the tube in glue ear appears to show that it is patent,
and if it is patent and fluid does not drain through it, it cannot be func-
tioning properly.

Allergy has been regarded as a cause, but the majority of patients show
no other evidence of allergy, and eosinophils are rarely, if ever, found in
the middle ear fluid. Inadequate or incorrect antibiotic therapy may be the
cause. If, for example, a child develops a virus infection of the upper respira-
tory tract with involvement of the Eustachian tube and middle ear cavity,
and if this is treated with antibiotics, no cure of the virus infection will occur.
Secondary pyogenic organisms will not supervene, and thus no acute suppur-
ation will take place in the middle ear. The fact that in the 1-3 years age
group red bulging drumheads may persist in spite of antibiotic therapy,
and that on myringotomy glue-like secretion may follow mucopus on aspira-
tion gives some weight to this theory.

The condition is extremely common in children with a cleft palate. This
might suggest that a chronic nasopharyngitis causes the middle ear condi-
tion, but it may be that during the surgical repair of the palate fracturing
of the hamulus alters the function of the Eustachian tube.

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