[Status of the controversial discussion of the pathogenesis and treatment of chronic otitis media with effusion in childhood].
BACKGROUND
Chronic otitis media with effusion is one of the most common diseases in childhood. The causes of otitis media are unclear as far as their importance is concerned.


METHODS
Extensive search in the German and Anglo-saxon literature with following presentation of the results.


RESULTS
The original idea of a mechanical obstruction of the eustachian tube by the adenoids seems to be insufficient. Inflammatory mechanisms as a result of pathogenic germs in the middle ear fluid stand opposite to immunomodulating mechanisms as relevant causes of chronic otitis media with effusion. There are references which lead to the importance of allergic co-mechanisms individually. The controversial discussion of the pathophysiology of chronic otitis media with effusion is illustrated by the different opinions of optimal treatment modalities. Varying medical treatment opportunities exist while centrally the importance of the use of antibiotics is controversial. Based on the absence of long lasting effects of medical treatments, there are groups supporting a wait-and-see policy. Concerning the long-term effects of operative treatment, the importance of isolate tubes insertion in opposition to a combined treatment modality (adenotomy and tubes) is controversial. The actual debate focusses on adenotomy or adenotonsillectomy without operating the middle ear as treatment modality in patients with otitis media with effusion.


CONCLUSIONS
Economic and social importance of this disease forces further investigations in pathogenesis and optimizing of medical and operative treatment modalities.
Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Philipps-Universität Marburg. duenne@mailer.uni-marburg.de
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Dünne
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Werner
D000233:Adenoidectomy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002908:Chronic Disease; D006801:Humans; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000209:etiology / Q000628:therapy*
D000900:Anti-Bacterial Agents