الفهرس 
Etiology and pathogenesis ofOnly 14 pages are availabe for public view
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Abstract
Otitis media with effusion (OME), which is often called glue ear, is an increasingly common presentation in primary care and the commonest reason for childhood surgery. A recent National Institute for Health and Clinical Excellence (NICE) review found that there are no proven effective medical treatments. (Williamson et al.,2009).
The current treatment options for OME include eliminating the risk factors, following up without treatment, use of antibiotic and/or decongestant medication, maneuvers to open the Eustachian tubes, prophylactic antibiotic use and, if medical treatment fails, tympanostomy tube placement with or without adenoidectomy.(Cengel & Akyol 2005).
Several lines of treatments for OME indicate that there is no settled way of management.
Recently, a potential role of corticosteroids in the treatment of OME has emerged .Short-term use of systemic steroids provides a temporary Improvement but long-term use of systemic steroids is not appropriate in children due to significant side-effects. On the other hand, topical nasal steroids without systemic side-effects might be used.
Methods of the study
Design
A single-blind randomized placebo-controlled trial design was used.
Patients
Eighty four children aged 4–11 yearswere included the sample was selected from children presenting to the ENT out patient clinic of El Mehalla El Kobra general hospital with one or more episodes of otitis media or ear-related problems in the previous 12 months, and whom were confirmed to have glue ear on both sides using tympanometry at entry into the main study.
Interventions
Fluticasone, a topical steroid, 50 mg squirted into each nostril, or placebo spray (in the form of nasal saline), once daily for 1 month. The control group was followed up without any treatment. No other medication was allowed during the study in either group.
Exclusion criteria
previous use of systemic or intranasal steroids in the last 3 months , surgery for these illnesses, active upper airway infections in the previous 2 weeks, history of immunodeficiency, hypersensitivity to Fluticasone, or any systemic and local contraindication to corticosteroids, adenoidal hypertrophy with chronic nasal obstruction as they are more suitable for surgery.
Evaluations and patient management
All patients were evaluated at 0 and 6 weeks. Assessment of each patient included history, a symptom questionnaire, a tympanogram, an otoscopic examination and plain x-ray lateral view. The ears were examined separately by otoscopy for tympanic membrane appearance and mobility was assessed by pneumatic otoscopy. Jerger type B flat tympanogram were considered to support the diagnosis of OME.
Statistical analysis
The data were analyzed with the ‘‘Statistical Package for the Social Sciences’’ (SPSS 17.0) .
Results
Resolution of OME in the study group (44.2%) was significantly higher than that in the control group (22%). These results indicate that topical nasal FLUTICASONE treatment deserves consideration as a line of medical treatment for OME.
Recommendation
these results are only short-term; a long-term follow-up is necessary.