Otitis media with effusion in childhood.

OM and OME are common disorders of childhood. Middle ear disease is related to anatomic abnormalities, prior episodes of AOM, chronic rhinitis, allergy, age, sex, race, season, perinatal factors, viral infections, and irritant exposure. ET dysfunction plays an important role in OME, as does the presence of bacteria or bacterial products in the middle ear. Viral infection, nasal allergy, previous episodes of OM and primary mucosal disease all may contribute to this chronic disorder. Diagnostic evaluation involves an appropriate personal and environmental history, a physical examination, pneumatic otoscopy, tympanometry, pure tone audiometry, and (if indicated) allergic and immunologic evaluation. Treatment may include environmental control, antibiotic therapy, decongestants and/or antihistamines, topical corticosteroids, and possibly immunization or allergic immunotherapy (hyposensitization). In order to facilitate strategies to prevent acute and recurrent OM as well as chronic effusion, further knowledge regarding the etiology, pathogenesis, and risk factors is essential. Well designed, controlled studies are imperative to provide further understanding and more effective treatment of this common, chronic and often very frustrating medical problem.