Ans:B.)Is painless.OTITIS MEDIA WITH EFFUSIONSynonyms: Serous Otitis Media / Secretory Otitis Media / Mucoid Otitis Media/ Glue Ear/Non-Suppurative Otitis Media/Silent Otits Media.Non purulent sterile effusion accumulates in the middle ear cavity.Painless conditionMCC of conductive deafness in school-going childrenETIOLOGY OF OTITS MEDIA WITH EFFUSIONMalfunctioning of Eustachian tube (adenoid hyperplasia, chronic rhinitis, sinusitis & tonsillitis, tumors of nasopharynx, cleft palate)Cause of U/L secretory otitis media in an adult is Nasopharyngeal Carcinoma.Patients with Wegener's Granulomatosis may present with Secretory Otitis MediaCharacteristic triad of Wegener's granutomatosis is vasculitis of the upper respiratory tract (serious otitis media and epistaxis), vasculitis of the lower respiratory tract (hemoptysis) and vasculitis of the kidney (proteinuria).AllergyUnresolved otitis mediaViral infection - adeno and rhinoviruses.CLINCAL FEATURES OF OTITS MEDIA WITH EFFUSIONSymptoms:Hearing loss (<40DB)Delayed and defective speechMild ear ache.Otoscopy :Dull and opaque tympanic membrane.Intact tympanic membrane.Colour may be Yellow/Grey/Blue.Loss of light reflexThin leash of blood vessels seen along the handle of malleus (less marked than ASOM)Retracted TMBulging of the posterior pa of TMFluid level and air bubbles seenMobility restrictedTuning fork tests :Conductive deafness of 20-40 dBImpedance Audiometry:confirmatory test for Secretory Otits Media,Shows Type -B curve.X-ray Mastoid: Clouding of air cells.MANAGEMENT OF OTITS MEDIA WITH EFFUSIONMedical Treatment:Decongestant , Anti allergic, Antibiotics , Middle ear aeration (Valsalva maneuver)Watchful waiting is recommended without immediate use of antibiotics for children with uncomplicated otitis media with effusion.Surgical Treatment:1. Myringotomy and fluid aspiration: 2 incisions one in the antero inferior and other antero superior quadrant of the TM to aspirate thick glue like secretions.(Beer can principle)2. Grommet inseion: left in place till spontaneously extrudedIn chronic secretory otitis media(also known as Glue ear), the treatment of choice is Myringotomy with ventilation tube inseion3. Tympanotomy (or) coical mastoidectomy-very limted role4. Surgical t/t of causative factor - adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.Treatment of choice in a patient presenting with mouth breathing, recurrent serous otitis media and adenoid facies is Adenoidectomy.SEQUELAE OF SOMAtrophic tympanic membrane and atelectasis of middle earOssicular necrosisTympanosclerosisRetraction pockets and cholesteatomaCholesterol granuloma