الفهرس 
• Physiology of the Eustachian tubeOnly 14 pages are availabe for public view
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Abstract
OME is one of the most common childhood diseases. It is also the most common cause of acquired hearing loss in childhood and has been associated with delayed language development and behavioural problems.
Risk of OME is increased with passive smoking, bottle feeding, low socioeconomic group, and exposure to many other children in unhealthy nurseries.
Up to 80% of children have been affected by the age of 4 years, but prevalence declines beyond 6 years of age.
Non-purulent middle-ear infections can occur in children or adults after upper respiratory tract infection or acute otitis media.
The otologic sequelae of OME are chronic suppurative otitis media, tympanosclerosis, adhesive otitis media, ossicular necrosis, retraction pockets and cholesteatoma.
It is recommended to manage the child with OME who has no history of previous attacks and not in school age (will not develop learning problems) i.e. not at risk with watchful waiting for 3 months from the date of effusion.
The management of associated nasal conditions or nasal allergy may improve ET malfunction.
Mucolytics have not been shown to have a long term effect. While antibiotics have a clinical and statistically significant cure rate. Amoxicillin– clavulanic acid have proved to be the most effective antibiotic for OME (only used for acute otitis media or acute exacerbation on top of chronic OME not for OME itself).
Surgical treatment options for OME are either to the ear to drain the fluid and prevent recurrence, or to the nasopharynx in an attempt to induce an effect on ETF and ascending infection.
Surgery should only be recommended for persistent disease with significant hearing loss causing symptomatic morbidity. The condition should be observed otoscopically and monitored with tympanometry and hearing tests for at least 3 months prior to listing for operation.
Adenoidectomy has been recommended with or without insertion of VTs in an attempt to alter ET function and ascending infection. Patients with adenoids abutting the torus tubaris may benefit most from an adjuvant adenoidectomy.
Though adenoidectomy was not found to produce extra hearing gain over VTs alone, it produced better normalization of middle ear function.
There is a significant benefit for the combined procedures (adenoidectomy and VTs) in terms of otoscopic clearance, tympanometric change and hearing gain.
VTs does not cure the condition but produce temporary improvement in hearing thresholds.
VTs improve hearing for the first 2 years, but have no longer-term benefit, and may not improve cognition or language development.
Adenoidectomy may improve hearing when performed with tympanostomy, but the clinicaln relevance of the improvements is unclear.
Combination treatment with VTs plus adenoidectomy may be more effective than adenoidectomy alone.
Persistent secretory otitis media can be associated with hearing loss, and mastoid surgery can significantly enhance the hearing level to produce positive therapeutic effects.
In patients with ET dysfunction that is refractory to medical management, newer surgical techniques may provide symptomatic relief with a reasonable duration. Continued basic science research into the cause of dysfunction, the mechanisms of benefit from intervention and long-term clinical outcomes are necessary.
Treatment options revealed that auto inflation of ET is the main stay of treatment. If the ET malfunction is due to any reasons like adenoids, deviated nasal septum, hypertrophied turbinates or any other cause surgical intervention of the same gives 100% results. Medical management gives good results but recurrence is equally common