Current standing of the controversial discussion of the aetiopathology andthe treatment of chronic otitis media with effusion in children.

Chronic otitis media with effusion is one of the most common diseases in ch ildhood. The causes of otitis media are unclear as far as their importance is concerned. Method: Extensive search in the German and Anglo-saxon litera ture with following presentation of the results. Results: The original idea of a mechanical obstruction of the eustachian tube by the adenoids seems t o be insufficient. inflammatory mechanisms as a result of pathogenic germs in the middle ear fluid stand opposite to immunomodulating mechanisms as re levant causes of chronic otitis media with effusion. There are references w hich lead to the importance of allergic comechanisms individually. The cont roversial discussion of the pathophysiology of chronic otitis media with ef fusion is illustrated by the different opinions of optimal treatment modali ties. Varying medical treatment opportunities exist while centrally the imp ortance 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 treatmen t, the importance of isolate tubes inseration in opposition to a combined t reatment modality (adenotomy and tubes) is controversial. The actual debate focusses on adenotomy or adenotonsillectomy without operating the middle e ar as treatment modality in patients with otitis media with effusion. Concl usions: Economic and social importance of this disease forces further inves tigations in pathogenesis and optimizing of medical and operative treatment modalities.