Myringotomy for acute postviral otitis media with effusion: rapid resolution of thick mucoid effusion and hearing loss−a case report

Otitis media with effusion (OME), often following viral illnesses such as seasonal influenza, is typically a self-limiting condition that rarely requires antibiotics. We report the case of a 35-year-old male with right-sided OME and persistent symptoms for over four weeks following an episode of influenza-like illness characterized by fever, fatigue, and myalgia. Clinical evaluation revealed a conductive hearing loss (pure tone average [PTA] of 43.7 dB HL), a Type B tympanogram, and a thick mucoid effusion, later confirmed intraoperatively. Myringotomy was performed under local anesthesia using an operating microscope, achieving immediate drainage without the need for tympanostomy tube placement or antibiotics. Adjunctive treatment with oxymetazoline nasal drops was provided to support Eustachian tube function. By day seven, the patient experienced full resolution of symptoms, with hearing improvement to 13.7 dB HL and normalization of tympanometry (Type A). This case underscores the value of myringotomy as a first-line intervention in select adult patients with post-influenza OME and supports evidence-based practices that avoid unnecessary antibiotic use in nonbacterial effusions.