The aetiology of secretory otitis media is not fully understood.
The following factors have been implicated which is thought to increase the risk of developing OME:
- age - 6 years or younger
- household smoking
- attending a day care centre
- large number of siblings
- low socioeconomic group
- recurrent upper respiratory tract infections
- bottle feeding (1).
The importance of Eustachian tube dysfunction is, however, widely accepted. One possible mechanism is that negative pressure develops within the middle ear cavity as a result of Eustachian tube dysfunction and the continual absorption of oxygen by respiratory epithelium. This negative pressure then encourages the formation of a mucosal transudate. Some common causes of tubal dysfunction are
- functional problems and its intrinsic system of opening and closing
- immunological and genetic disorders
- gastroesophageal reflux
- rhinosinusitis
- enlarged adenoid (2)
Thus, secretory otitis media may be caused by:
- nasopharyngeal obstruction:
- large adenoids
- nasopharyngeal tumours in adults
- otic barotrauma
- sinusitis
- there is an increased incidence in
- cleft palate - due to impaired function of the Eustachian tube associated with palatal anomaly (2)
- Down's syndrome - caused by impaired immune system and mucosal abnormality which results in an increased susceptibility to ear infection (2)
- allergic rhinitis may also predispose to secretory otitis media by affecting Eustachian tube function.
- passive smoking may be a factor
However, many cases of secretory otitis media have no apparent cause.
Reference:
- Williamson I. Otitis media with effusion. Clinical Evidence 2006
- Di Francesco R et al. Craniofacial morphology and otitis media with effusion in children. Int J Pediatr Otorhinolaryngol. 2008;72(8):1151-8
- NICE. Otitis media with effusion in under 12s. NICE guideline NG233. Published August 2023.