<prompt> Glue ear:Is painfulIs painlessRadical mastoidectomy is requiredNaF is useful  <response>: Ans:B.Is painless.OTITIS MEDIA WITH EFFUSIONSynonyms: Serous Otitis Media Secretory Otitis Media Mucoid Otitis Media Glue EarNon-Suppurative Otitis MediaSilent 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 palateCause of UL secretory otitis media in an adult is Nasopharyngeal Carcinoma.Patients with Wegeners Granulomatosis may present with Secretory Otitis MediaCharacteristic triad of Wegeners 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 40DBDelayed and defective speechMild ear ache.Otoscopy :Dull and opaque tympanic membrane.Intact tympanic membrane.Colour may be YellowGreyBlue.Loss of light reflexThin leash of blood vessels seen along the handle of malleus less marked than ASOMRetracted 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 maneuverWatchful 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 principle2. Grommet inseion: left in place till spontaneously extrudedIn chronic secretory otitis mediaalso known as Glue ear, the treatment of choice is Myringotomy with ventilation tube inseion3. Tympanotomy or coical mastoidectomy-very limted role4. Surgical tt of causative factor - adenoidectomy, tonsillectomy, andor 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 