الفهرس 
Introduction
Prognostic and risk factors in OMEOnly 14 pages are availabe for public view
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Abstract
Otitis media with effusion is considered to be the most common cause of childhood deafness. chronic secretory otitis media is a common disease in children, especially in developing countries. In these countries secretory otitis media may pass unnoticed for a long time and then develop slowly into a chronic condition. It may then cause hearing impairment (Balle et al., 2000). Moreover, otitis media with effusion can lead to persistent pathological changes like atrophy, tympanosclerosis, and adhesive otitis media. This disease can present in different forms because of the large variation in the nature of the middle ear effusions, which can vary from a clear effusion without distinct signs of infection to a cloudy or purulent fluid (Wielinga et al., 2001).In spite of the common occurrence of secretory otitis media, its etiology and pathobiology are still largely unknown. Causes of this disorder are believed to be multifactorial, including viruses, allergy, bacteria and their products, and dysfunction of the eustachian tube (Salonen et al., 1989). Gastro-esophageal reflux (GER) could also be a cause of this disease. Reflux of gastric contents from the nasopharynx to the middle ear is possible because of the angle and immaturity of the Eustachian tube in children and infants, and the supine position in which infants are often placed (Tasker et al., 2002) Mild forms of secretory otitis media may clear in few months’ time by themselves or after the removal of the middle ear fluid. In persistent cases, surgical measures like adenoidectomy and placement of ventilation tubes become mandatory in the effort to achieve a cure. Even then, about 30% of the patients show continuing or -2-recurrent disease after one year (Salonen et al., 1989).