Chronic nonsuppurative otitis media with effusion is middle ear inflammation with associated fluid accumulation. Acute otitis media can evolve into chronic nonsuppurative otitis media.

Chronic serous otitis media can be due to a persistent swelling or inflammation of the adenoids with associated blockage of the eustachian tube. The recurrent blockage or scarring of the eustachian tube from previous infections, nasal allergies ,or nasopharyngeal masses may cause chronic serous otitis media. Chronic otitis media with effusion may result from an intractable or persistent infection despite recurrent or prolonged antibiotic treatment.

The condition may become well-established before it causes discomfort. Complaints may include earache, otorrhea, and hearing loss. Signs may include: poor or absent tympanic membrane mobility; a cyst-like mass in the middle ear; (cholesteatoma, see Diagnostic Code: 6209 Benign neoplasms of the ear); and conductive hearing loss which may vary with the size and type of tympanic membrane perforation and bony (ossicular) destruction. There may also be thickening and scarring of the tympanic membrane.

Tests may include otoscopy with pneumatoscopy which may show decreased tympanic membrane mobility. Routine x-rays or computed tomography (CT) scans of the temporal bones may be performed in suspected cases of mastoiditis.

Treatment may include: antibiotics; removal of the eustachian tube obstruction; myringotomy and tube insertion; and tympanoplasty. If a cholesteatoma is present in the middle ear, tympanomastoidectomy may be required.

Residuals may include conductive, sensory or mixed hearing loss.

• Evaluate based on hearing impairment with the application of tables VI, VIa ,and VII (38 CFR 4.85 and 38 CFR 4.86)
• is payable for the combinations of service-connected and nonservice-connected disabilities specified in 38 CFR 3.383(a)(3)(see below) as if both disabilities were service-connected, provided the nonservice-connected disability is not the result of the veteran's own willful misconduct.
• Hearing impairment in one ear that is compensable to a degree of 10 percent or more as a result of a service-connected disability and hearing impairment as a result of a nonservice-connected disability that meets the provisions of 38 CFR 3.385 in the other ear.

Notes

• If there is continuous SC infection of the upper respiratory tract, the time cited for the purpose of service connecting infection of the second ear should be extended indefinitely.
• When evaluating any claim for impaired hearing, refer to 38 CFR 3.350  to determine whether the veteran may be entitled to special monthly compensation due either to deafness or to deafness in combination with other specified disabilities.