الفهرس 
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Abstract
Otitis media with effusion (OME) is defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection.
OME is characterized by the presence of fluid in the middle ear with intact tympanic membrane which is often cloudy with distinctly impaired mobility and an air-fluid level or bubbles may be visible in the middle ear.
Approximately 90% of children (80% of individual ears) have OME at some time before school age most often between ages 6 months and 4 years.
Many events are advocated in the pathogenesis of OME: inflammation, adenoid hypertrophy, craniofacial growth abnormalities causing nasal obstruction and a reduction of local and/or systemic immune response associated with inadequate ET function.
Patients suffer from deafness, aural fullness and tinnitus. Children show failure to respond appropriately to voices or environmental sounds, lack of attention and behavioral changes.
The hearing loss in OME is often transient as the middle ear effusion frequently resolves spontaneously espe¬cially if OME follows an episode of AOM.
Many children with OME do not require treatment due to high rates of spontaneous resolution. However when OME is bilateral and persistent for more than 3 months the chances of natural resolution are much lower and treatment may be beneficial.
Currently middle ear aeration via tympanotomy and tube insertion has been the choice of management for chronic effusions that do not respond to medical therapy.
Our study was carried out on 68 patients with 80 ears{56 unilateral cases and 12 bilateral cases (80 ears)} with recurrent otitis media with effusion and refused reinsertion of the ventilation tubes, aged 12-45 years old divided into 2 groups (group A and B) each group contained 40 ears.
group A patients included 35 patients {30 unilateral ears and 5 bilateral ears (40ears)} were treated with intratympanic injection of dexamethasone and group B patients included 33 patients {26 unilateral ears and 7 bilateral ears (40 ears)}were received conventional medical treatment in the form of oral antibiotics, local nasal decongestant, mucolytic agents and systemic steroids.
They were compared with each other in improvement of the ear symptoms, signs, tympanometric type and air- bone gap in pure tone audiometry (PTA) and any complications were reported after ITD.
The results of study were:
• There was a statistically significant difference between both groups (A and B) regarding post treatment improvement in the symptoms as deafness, aural fullness and tinnitus (P=0.036).
• There was a statistically significant difference between both groups (A and B) regarding post treatment improvement in the signs as retraction of tympanic membrane and absence of the cone of light (P=0.036).
• There was a statistically significant difference between both groups regarding the post treatment tympanometric type, as the figures for post- type A in group A were remarkably higher than that in group B; 22 ears (55%) in group A and 8 ears (20%) in group B (p<0.05). Also, the number of patients with type B in group B was more than that of group A (p=0.003).
• There was a statistically significant difference between group A and group B regarding the post-treatment air bone gap of the subjects, as the figures for post treatment gap of group A patients were remarkably lower than that of group B; 6.88±8.73 in group A patients and 11.58±10.88 in group B (p<0.05).
• There was improvement of the air bone gap post- treatment in both groups. As shown, both groups witnessed significant improvements in the gaps post treatment; from 23.10±2.65 to 6.88±8.73 in group A and from 23.30±3.15 to 11.58±10.88 in group B, however the improvement in group A was more significant (P =0.036)
• No complications as AOM, intolerance or persistent tympanic membrane perforation were reported in group A patients post ITD.