1. Caveat
   Unilateral serous otitis media (a.k.a. chronic otitis media with effusion) in an adult requires one to R/O nasopharyngeal carcinoma
   
   
2. Antibiotics
   
   

   First Line:

   Amoxicillin 500 mg p.o. qid x 7-10 days

   or if PCN allergic

   E-Mycin 333 mg p.o. qid x 7-10 days or

   Septra DS i p.o. bid x 7-10 days
   
   

   Second Line:

   Augmentin 875 mg p.o. bid x 7-10 days

   Pediazole (Pediatrics) or

   3rd generation cephalosporin
   
   

3. Persistence is diagnosed by otoscopy or pneumotoscopy. Tympanometry is an unnecessary expense, but is accepted to assist in diagnosis.
   
   
4. Hearing loss documentation is by audiogram with or without tympanogram.
   
   
5. Myringotomy and tubes is safe, cheap and effective. Adenoidectomy may be indicated for the 2nd or 3rd set of tubes. Tonsillectomy is indicated for tonsillitis.

Overview of Serous Otitis Media

Serous otitis media (a.k.a. chronic otitis media with effusion) is a condition in which the middle ear is inadequately aerated and has abnormal fluid accumulation. This is generally felt to be secondary to eustachian tube dysfunction. Eustachian tube physiology is a function of age, growth, development, rhinitis, sinusitis, adenoid hypertrophy, upper respiratory tract infection and a myriad of other problems. For example, individuals with cleft palate have abnormalities of their tensor tympani muscle. The eustachian tube malfunctions and virtually all cleft palate children have chronic otitis media. All cleft palate children and adults require middle ear ventilation tubes.

The treatment for serous otitis media is controversial. When I was younger, I practiced all sorts of very complex treatment regimes. The older I get, and the more patients with this illness I see, the more I believe the illness is in the hands of "mother nature and father time" and the only thing that I, as a health professional, can do to assist is to provide appropriate, safe antibiotics to treat and sometimes prevent infection.

I normally give "mother nature" three months to resolve the serous otitis media. During this time it is appropriate to give a minimum of one two-week course of antibiotics. Other treatments be they topical, systemic, herbal, medicinal or mystical are perfectly acceptable presuming they follow the Latin adage, primum non nocere.

If at 3 months post diagnosis of serous otitis your examination reveals persistant fluid and a hearing loss exists, the individual should be recommended for myringotomy and tubes. Hearing impaired children, even those with a very minimal conductive hearing impairment, have lifelong learning disabilities with documented decrement in language and verbal aptitude.

If the fluid persists, but there is no decrement in hearing, and there is reason to wait, i.e. we have come to the end of cold season, we are nearing the end of the seasonal allergy season, we are leaving day care centers, you can wait another four weeks. However, if it is clear that a drainage procedure will ultimately be required, it is better to recommend and perform the procedure early, rather than late.