Etiologic factors in the development of chronic middle ear effusions.

Many factors increase the risk for CMEE in children. We believe the most important include recurrent purulent otitis media, chronic nasal congestion, atopy, and household cigarette smoke exposure. The risk of each of these in causing middle ear disease increases with the chronicity of the exposure. The risk may be additive, with a combination of these factors. CMEE undoubtedly develops through several mechanisms. It is important to look for specific risk factors, as their identification may afford potential approaches toward the prevention of recurrences. Theories such as prophylactic antibiotic administration, pneumococcal vaccination, pharmacologic therapy with antihistamines, decongestants and/or steroids, immunotherapy, and the avoidance of household irritants may be selectively beneficial for the appropriate individual. In an attempt to facilitate strategies to prevent acute middle ear disease as well as recurrent and chronic effusions, further understanding of the etiology, pathogenesis, and risk factors is prerequisite. Additional controlled studies in all of these areas are essential so that we may expand our knowledge base and offer more definitive recommendations to our patients and their families.