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H65.3 – Chronic Mucoid-Serous Otitis Media
H65.3 is the ICD-10 code for chronic mucoid-serous otitis media, commonly known as glue ear. Fluid accumulates behind the eardrum, often causing hearing loss, especially in children.
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H65.3 is the ICD-10 code for chronic mucoid-serous otitis media, commonly known as glue ear. Fluid accumulates behind the eardrum, often causing hearing loss, especially in children.
Definition and Overview
H65.3 is a diagnostic code from the ICD-10 classification system, representing chronic mucoid-serous otitis media, also commonly known as glue ear or otitis media with effusion (OME). This is a non-infectious condition of the middle ear in which thick, sticky fluid accumulates behind the eardrum without the presence of acute infection or eardrum perforation. It is one of the most common causes of hearing loss in children.
Causes
The condition primarily results from dysfunction of the Eustachian tube, which connects the middle ear to the back of the nose and throat and is responsible for pressure regulation and ventilation of the middle ear. Common contributing factors include:
- Recurrent upper respiratory tract infections
- Enlarged adenoids blocking the Eustachian tube opening
- Respiratory allergies
- Anatomical abnormalities (e.g., cleft palate)
- Passive exposure to cigarette smoke
- Attendance at childcare facilities with increased exposure to infections
Symptoms
Glue ear often presents with mild or subtle symptoms, which can make it easy to overlook, especially in young children. Typical signs include:
- Hearing loss (conductive type) in one or both ears
- A sensation of fullness or blockage in the ear
- Occasional mild tinnitus (ringing or buzzing sounds)
- In children: delayed speech and language development, inattentiveness, or behavioral changes
Pain is usually absent or minimal, which distinguishes glue ear from acute otitis media and often leads to delayed diagnosis.
Diagnosis
Diagnosis is typically made by an ENT specialist (Ear, Nose and Throat doctor). Key diagnostic tools include:
- Otomicroscopy: Direct visualization of the eardrum, which appears retracted, dull, and sometimes amber-colored
- Tympanometry: A test measuring eardrum mobility; a flat (type B) curve is characteristic of OME
- Audiogram (hearing test): Confirms conductive hearing loss
- Otoscopy: May reveal visible fluid level or air bubbles behind the eardrum
Treatment
Treatment decisions are based on the severity of hearing loss, duration of symptoms, and the age and developmental needs of the patient.
Watchful Waiting
In many cases, especially in children, the effusion resolves spontaneously within three months. Regular monitoring is recommended during this period, with hearing assessments as needed.
Conservative Management
- Treatment of underlying conditions such as allergies or chronic rhinitis
- Eustachian tube autoinflation using devices such as the Otovent balloon
- Short-term use of decongestant nasal sprays
Surgical Treatment
- Myringotomy with grommet (tympanostomy tube) insertion: A small ventilation tube is inserted into the eardrum to restore middle ear aeration and allow drainage of fluid. This is the most common surgical procedure for persistent glue ear in children.
- Adenoidectomy: Removal of enlarged adenoids, often performed alongside grommet insertion when adenoids are identified as a contributing factor
Prognosis and Outlook
The prognosis is generally favorable with timely treatment. However, if left untreated, chronic glue ear can lead to permanent hearing impairment, delays in speech and language development, or structural changes to the eardrum such as retraction pockets or cholesteatoma formation. Regular follow-up is therefore essential.
References
- World Health Organization (WHO): ICD-10 Version 2019 – H65.3 Chronic mucoid otitis media. Available at: https://icd.who.int/browse10/2019/en#/H65.3
- Rosenfeld RM et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology – Head and Neck Surgery, 2016;154(1 Suppl):S1-S41.
- National Institute for Health and Care Excellence (NICE): Otitis media with effusion in under 12s: surgery (NICE guideline NG215), 2023. Available at: https://www.nice.org.uk/guidance/ng215
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