Middle-ear fluid, if persistent, may cause permanent changes in the drum. An otitis media with effusion can cause hearing loss for decades, and the diagnosis is frequently overlooked in a long-standing hearing loss. Impedance audiometry helps in diagnosis.
brown color, with retraction of a flaccid membrane onto the ossicles and promontory, is seen with long-standing middle-earfluid. (Bottom arrow: indrawn drum onto the promontory; top arrow: incudostapedial joint.)
Fig. 2.82 Grommet occluded with exudate. Insertion of a grommet in these chronic adult cases may restore hearing, but frequently either the lumen of the grommet becomes occluded with exudate, which may extrude through the tube into the meatus, or a constant otorrhea occurs.
There is no successful treatment at present for chronic otitis media with effusion when this fails to respond to insertion of a grommet. A further problem with chronic otitis media with effusion is the return of middle-ear fluid with hearing loss when the grommet extrudes. A larger flanged grommet (long-term grommet) which remains in position longer, and periodic replacement are the present remedies.
Fig. 2.83a The grommet lumen may also become obstructed with blood if the myringotomy incision bleeds excessively.
b Infection with a granuloma may also occlude the lumen. Although this type of granuloma may respond to an antibiotic and steroid eardrops, it is frequently necessary for the grommet to be removed.
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