From the Research
Treatment for an adult with serous otitis should prioritize watchful waiting for 3 months, as many cases resolve spontaneously, and if symptoms persist, consider medical management with nasal steroids or oral decongestants, and surgical intervention for persistent cases with significant hearing loss or discomfort. The management of serous otitis media (SOM) in adults involves a step-wise approach, starting with observation due to the high rate of spontaneous resolution, as noted in studies such as 1. If symptoms persist beyond 3 months, the use of nasal steroids like fluticasone or oral decongestants such as pseudoephedrine may be beneficial, as these can help reduce inflammation and improve eustachian tube function, thereby alleviating the condition, as suggested by the general principles of managing otitis media with effusion. Some key points to consider in the management of serous otitis include:
- The importance of diagnosing and treating underlying causes such as allergies or anatomical issues like adenoid hypertrophy, as these can contribute to eustachian tube dysfunction and the development of serous otitis, as discussed in 2 and 3.
- The role of autoinflation techniques and devices like the Otovent in helping to equalize pressure and improve eustachian tube function, which can be particularly useful for patients with persistent symptoms, as implied by the principles of middle ear ventilation.
- The consideration of surgical intervention, including myringotomy with tympanostomy tube placement, for cases that do not respond to medical management and have significant hearing loss or discomfort, as this can provide immediate relief by draining the fluid and ventilating the middle ear, as mentioned in 4 and 3. It's also important to note that antihistamines are not generally recommended for the treatment of serous otitis media unless there is a clear allergic component, as their use has been questioned in guidelines and studies such as 5, emphasizing the need for targeted therapy based on the underlying cause of the condition. Given the most recent and highest quality evidence, the approach to treating serous otitis in adults should focus on a stepped care model, starting with watchful waiting and progressing to medical and potentially surgical interventions based on the severity and persistence of symptoms, as well as the presence of underlying contributing factors, as generally supported by the principles outlined in 3.