If Eustachian tube blockage continues for prolonged periods and no organism invades, then the fluid collected inside middle ear will be sterile (non-infective).
This condition is called ‘Otitis media with effusion / Serous otitis media / Glue ear.’
Here, there is no complaint of pain as there is no infection or inflammation.
Common causes include hypertrophied adenoids + tonsils or cleft palate or inadequate ASOM treatment (Biofilm formation by the bacteria can resist antibiotics and hence, they persist inside even after antibiotic course and causes excess irritation of mucosa thereby causing excess fluid secretion. Here, the fluid is sterile on testing because bacteria are not free-floating).
To drain the fluid, myringotomy (a small opening in tympanic membrane) is done and all the fluid will now drain outside.
Most common site for myringotomy is antero-inferior quadrant.
Radial type of incision given here (curvilinear incision is given in ASOM).
Grommet (ventilation tube) inserted through myringotomy for permanent drainage of freshly forming fluid.
If hypertrophied adenoids is the cause found, then adenoidectomy should be done at the same time.