الفهرس 
Endoscopy and Biopsy
Anatomic obstructionOnly 14 pages are availabe for public view
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Abstract
OME is characterized by nonpurulent effusion of the middle ear. It
remains the most common cause of deafness in childhood.
Pathogenesis of OME can be explained by ET dysfunction which
will lead to accumulation of fluids in middle ear. This dysfunction has so
many causes but overall it can be classified into: (1) impairment of
pressure regulation; (2) loss of protective function; and (3) impairment of
clearance.
Treatment of OME in children include prevention, medical
treatment (in the form of corticosteroids, antimicrobial agents,
antihistamines and decongestant), surgical treatment (in the form of
myringotomy and ventilation tube insertion) if the patient become a
candidate for surgery.
In the past few years the idea of gastric contents insulting the ET
and/or middle ear mucosa became attractive to help explain the
pathogenesis of OME. The presence of gastric contents in the
rhinopharyngeal area and consequently the pharyngeal orifice of the ET
and with repeated exposure will lead to stasis, impairment of clearance
and loss of ventilatory function which will lead to OME.
GERD is the most common gastroenterological disorder that leads
to referral to pediatric gastroenterologist. Symptoms of GERD vary
according to the age of the patient, in infants the most common symptoms
include recurrent vomiting, feeding refusal, failure of weight gain and it
may be presented with complications like repeated pneumonia or asthma.
In children from 1 to 5 years symptoms include feeding refusal, recurrent
vomiting, abdominal pain and anorexia. In older children symptoms
resemble adults like heartburn, epigastric pain and dysphagia. Diagnosis
of GERD can be confirmed by investigations which include: esophageal
multiple intraluminal impedance and PH monitoring,motililty studies,
endoscopy and biopsy, barium contrast radiography, nuclear scintigraphy
and esophageal and gastric ultrasonography.Treatment of GERD in children include life style modifications,
pharmacotherapeutic agents (include acid suppressants and prokinetic
agents) and surgical treatment.
In the last decade several studies have been made in trials to prove
the relation between OME and GERD with variable results but most of
them were in the favor of proving this relation, They included
questionnaires searching for symptoms of GERD in OME patients,
collecting middle ear effusion samples and searching for pepsin,
pepsinogen and HP in it, using 24 hours Ph monitoring in patients with
OME and detecting the role of antireflux therapy in patients with OME.