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H65.1 – Chronic Non-Suppurative Otitis Media
H65.1 is the ICD-10 code for chronic non-suppurative otitis media, a long-lasting middle ear condition involving fluid buildup without pus, common in children.
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H65.1 is the ICD-10 code for chronic non-suppurative otitis media, a long-lasting middle ear condition involving fluid buildup without pus, common in children.
What is H65.1?
The ICD-10 code H65.1 refers to chronic non-suppurative otitis media – a persistent inflammation of the middle ear in which fluid accumulates behind the eardrum without the presence of bacterial pus. This condition is also known as glue ear, otitis media with effusion (OME), or serous otitis media. It is one of the most common causes of hearing loss in children worldwide.
Causes
Chronic non-suppurative otitis media typically develops when the middle ear cannot ventilate properly. Common causes include:
- Eustachian tube dysfunction: Impaired function of the tube connecting the middle ear to the back of the throat prevents normal pressure equalization.
- Enlarged adenoids: Particularly in children, swollen adenoid tissue can block the Eustachian tube opening.
- Recurrent upper respiratory infections: Repeated colds or viral infections can lead to persistent fluid accumulation.
- Allergies: Allergic inflammation of the nasal mucosa contributes to tube swelling and blockage.
- Passive smoke exposure: Exposure to tobacco smoke, especially in children, increases the risk significantly.
- Anatomical factors: Conditions such as cleft palate or craniofacial abnormalities predispose individuals to this condition.
Symptoms
Symptoms of chronic non-suppurative otitis media often develop gradually and may go unnoticed, particularly in young children:
- Hearing loss: The most common and significant symptom; sounds may appear muffled or distant.
- Sensation of fullness or pressure in the ear: A feeling of blockage or congestion in the affected ear.
- Tinnitus: Occasional mild ringing or buzzing sounds in the ear.
- Delayed speech and language development in children: Reduced hearing ability can impair language acquisition.
- Difficulties with concentration and school performance: Particularly relevant for school-aged children.
- Little or no ear pain: Unlike acute otitis media, significant pain is usually absent.
Diagnosis
Diagnosis is made by an ear, nose and throat (ENT) specialist using several examination methods:
- Otoscopy: Visual examination of the eardrum; in H65.1, the eardrum may appear retracted, dull, or yellowish due to fluid behind it.
- Tympanometry: Measures the mobility of the eardrum and middle ear pressure; a flat (type B) curve is characteristic of fluid in the middle ear.
- Audiometry: Assesses the degree of hearing loss in one or both ears.
- Nasoendoscopy: Examination of the nasal passages and Eustachian tube openings, particularly to assess adenoid size.
Treatment
Treatment depends on the severity, duration of the condition, and the age of the patient:
Watchful Waiting
In mild cases, a period of watchful waiting over several weeks is often recommended, as many cases resolve spontaneously, particularly in younger children.
Medical Treatment
- Decongestant nasal sprays or saline nasal rinses to support Eustachian tube function.
- Antihistamines if an allergic condition is identified as a contributing factor.
- Intranasal corticosteroids: To reduce mucosal swelling and improve tube ventilation.
Surgical Treatment
- Myringotomy (eardrum incision): A small incision in the eardrum to drain the accumulated fluid.
- Tympanostomy tube insertion (grommets): Placement of a small ventilation tube in the eardrum to allow ongoing middle ear aeration; commonly performed in children with recurrent or persistent cases.
- Adenoidectomy: Surgical removal of enlarged adenoids when they are identified as the primary cause.
Follow-up and Prognosis
Regular ENT follow-up appointments are essential to monitor hearing status and detect potential complications such as conductive hearing loss, eardrum scarring, or the development of a cholesteatoma at an early stage.
References
- Rosenfeld RM et al. – Clinical Practice Guideline: Otitis Media with Effusion. Otolaryngology – Head and Neck Surgery, 2016; 154(1 Suppl): S1-S41.
- World Health Organization (WHO): Chronic suppurative otitis media. Burden of illness and management options. Geneva, 2004.
- Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ – Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database of Systematic Reviews, 2010.
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