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H65.2 Chronic Serous Otitis Media

H65.2 is the ICD-10 code for chronic serous otitis media, a condition where fluid builds up in the middle ear. Learn about causes, symptoms, and treatment.

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Things worth knowing about "H65.2"

H65.2 is the ICD-10 code for chronic serous otitis media, a condition where fluid builds up in the middle ear. Learn about causes, symptoms, and treatment.

What is H65.2?

The ICD-10 code H65.2 refers to chronic serous otitis media, commonly known as glue ear or chronic middle ear effusion. In this condition, a non-infectious, watery or mucous fluid accumulates persistently in the middle ear cavity without signs of acute infection. It is one of the most common childhood ear conditions but can also affect adults.

Causes

Chronic serous otitis media is most often caused by impaired function of the Eustachian tube, which connects the middle ear to the back of the throat and is responsible for pressure equalization. When this tube does not open or close properly, fluid can collect in the middle ear.

Recurrent or incompletely resolved acute middle ear infections
Enlarged adenoids (adenoid hypertrophy)
Allergies or chronic upper respiratory tract conditions
Anatomical features of the Eustachian tube, especially in young children
Cleft palate
Passive smoke exposure in children

Symptoms

Chronic serous otitis media is often painless but may cause the following complaints:

Hearing loss (conductive hearing loss) as the most common symptom
A feeling of pressure or fullness in the ear
Occasional crackling or popping sounds in the ear
Delayed speech and language development in children due to hearing loss
Difficulties with concentration or behavioral problems in children

Diagnosis

Diagnosis is made by an ear, nose and throat (ENT) specialist using the following examinations:

Otoscopy: Inspection of the eardrum (typically retracted, dull, or yellowish in appearance)
Tympanometry: Measurement of eardrum mobility; in H65.2, often shows a flat type B curve
Audiometry: Hearing test to assess the degree of hearing loss
Nasopharyngoscopy: Assessment of the adenoids and Eustachian tube opening

Treatment

Watchful Waiting

In children under two years of age or at first presentation, a period of watchful waiting of several weeks is typically recommended, as many cases resolve spontaneously.

Conservative Treatment

Treatment of underlying allergies or upper respiratory infections
Decongestant nasal sprays or antihistamines (if allergy is confirmed)
Pressure equalization exercises (e.g., the Valsalva maneuver)

Surgical Treatment

Myringotomy with insertion of tympanostomy tubes (grommets): The most common surgical procedure; allows drainage of fluid and improves ventilation of the middle ear
Adenoidectomy: Surgical removal of enlarged adenoids, often combined with grommet insertion in children

Prognosis

In most children, chronic serous otitis media resolves on its own by school age. In cases of persistent hearing loss or delayed speech development, early treatment is important to prevent long-term complications.

References

Rosenfeld RM et al.: Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology - Head and Neck Surgery, 2016; 154(1 Suppl): S1-S41.
World Health Organization (WHO): ICD-10 Version 2019 - H65.2 Chronic serous otitis media. Geneva, 2019.
National Institute for Health and Care Excellence (NICE): Otitis media with effusion in under 12s: surgery. NICE Guideline NG91, 2008 (updated 2023).

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