Treatment of secretory otitis media in adults: our experience

Secretory otitis media [SOM] is the usual type of middle ear effusion in adults, characterized by presence of thin [serous] non purulent fluid in the middle ear space. To evaluate the response to conservative medical treatment of serous otitis media versus surgical treatment [myringotomy]. A prospective study enrolling 54 patients with SOM, aged 21-60 years was conducted during the period from the September 2006 to the October 2007 at Al-Kadhimiyia teaching hospital in Baghdad. Medical treatment used for 10-14 days. The response to treatment was evaluated 2 weeks following medical treatment using symptomatic improvement, tympanogram and pure tone audiogram. 39 patients did not respond to medical treatment were treated by myringotomy and aspiration of middle ear fluid [under local anesthesia] was done and the response was evaluated, after 1 and 2 months by using the same above mentioned assessment methods. 72% of the patients didn't improve following medical treatment, 77% of them have bilateral serous otitis media. Myringotomy was done for these non-responders; of whom 95% were improved. Myringotomy was effective, safe and easy method for treating adults with SOM did not improve following conservative medical treatment and, or for those who asked for an immediate relief of their symptoms, with a low recurrence rate

Use of gelfoam for grafting traumatic tympanic membrane perforation

Many procedures using different materials [e.g. gelfoam] have been tried to close the tympanic membrane perforation in an attempt to enhance and hasten the healing process of the tympanic membrane. To evaluate the results of gelfoam patch in patients with recent traumatic perforations of the tympanic membrane of different sizes. This study was performed on [52] patients with traumatic tympanic membrane perforation in Al-Kadhimiyia Teaching Hospital in Baghdad [from January to December 2007]. The perforations were classified into 4 Grades according to size [GI:<25%, GII:25-50% or multiple perforations involving 2 quadrants,GIII:50-75% or multiple perforations involving 3 quadrants, GIV: more than 75%]. After gentle cleansing of the external auditory canal, the perforations were patched with a Gelfoam impregnated with blood taken from the same patient by fine needle aspiration. These patients were followed up at 3 weeks, 6 weeks, and 3 months intervals during which another otological and audiometrical assessment was performed. The closure rates were 100%, 87%, 57% for grades I, II and III perforations respectively. Whereas none of the grade IV perforations were healed. Small perforations needed the least time for closure [average duration was 4.5 weeks], while larger perforations needed longer duration for closure [average duration was 11 weeks]. No correlation was found between closure rate neither with the location of the perforation nor with the age of the patient. Gelfoam patching improves the closure rate of traumatic tympanic membrane perforations. It is technically simple, safe to perform, and suitable as an outpatient procedure and has a good success rate. It is recommended to use this procedure for patients with recent traumatic tympanic membrane perforation especially for small and medium size perforations