All are true about serous otitis media except

Serous otitis media Serous otitis media (SOM) has many synonyms : Serous otitis media, otitis media with effusion, glue ear, non-suppurative otitis media, mucoid otitis media, silent otitis media. SOM is an insidious condition in which there is thick or sticky non-purulent fluid behind the eardrum in the middle ear, but there is no ear infection, i.e., effusion of middle ear without infection. Fluid in the middle ear is sterile. SOM occurs most commonly in school going children and SOM is the commonest cause of childhood hearing loss.Etiopathogenesis1) Eustachian tube dysfunctionEustachian tube dysfunction, coupled with recurrent upper respiratory tract infection is the most impoant factor in the development of SOM. Normally eustachian tube helps to drain fluids to prevent them from building up in the ear. In Eustachian tube dysfunction, it is unable to drain the fluid. Following can cause Eustachian tube block :-Respiratory tract infection :- Adenoid, rhinitis, tonsillitis, sinusitis.AllergiesBenign and malignant tumor of nasophar-ynx.2) Unresolved otitis mediaInadequate antibiotic therapy in acute suppurative otitis media may inactivate infection but fails to resolve it completely. Low grade infection lingers on and acts as stimulus for mucosa to secrete more fluid.Clinical featuresUnlike children with an ear infection (ASOM), children with SOM do not act sick. o The only presenting symptom may be hearing loss with fullness in ear.Otoscopic finding of SOMAir bubbles on the surface of ear drumFluid behind the eardrum.Dullness of the eardrum when a light is used, with loss of light reflex. o Eardrum may appear yellow, grey or bluish in colour.Retracted eardrum with decreased mobilityTympanometry shows type B tympanogram.