otitis media with effusion ( ome ) is the fluid in the middle ear with no signs or symptoms of acute ear infection.1 relentless middle - ear fluid from ome results in decreased mobility of the eardrum and serves as a barrier to sound conduction.2 the eardrum is often cloudy with distinctly weakened mobility , and an air - fluid level or bubble may be visible in the middle ear.3 about 2.2 million diagnosed episodes of ome occur yearly in the united states , resulting in a combined direct and indirect annual cost estimate of four billion dollars.4 approximately 90% of children have otitis media with effusion before school age , frequently between ages 6 months and 4 years.5 
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we investigated the frequency of serous otitis media in patients referred to the pediatric clinic between 316 years of age without any active ear , nose , and throat complaints in our study .
this study included 589 children patients ( 280 boys , 309 girls ; mean age : 9.42 ; range 316 ) who were administered to the pediatric clinic without otolaryngologic complaints ( fig .
the ethics board granted approval for the study , and each individual signed the informed consent form .
the inclusion criteria applied in the selection of subjects were children belonging to the age group from 316 years old .
exclusion criteria were patients aged less than 3 years and over 16 years ; patients having active otorhinolaryngological symptoms ; cleft palate repair history in the past and cases with submucous cleft palate ; and patients having ear wax .
patients underwent examination with flexible nasopharyngoscope ( fiegert - endotech , tuttlingen , germany ) for adenoid hypertrophy .
the scaling of adenoid hypertrophy was according to grade given by clemens and mcmurray,7 which is : grade i has adenoid tissue filling 1:3 the vertical tallness of the choana , grade ii up to 2:3 , grade iii from 2:3 to almost complete but not completely filling the choana , and grade iv with complete choanal obstruction . in our study , we considered grade ii - iii - iv as adenoid hypertrophy .
an otorhinolaryngologist examined all children on both ears using an otoscope and tested them with tympanometry .
we classified tympanometric measurement results according to adjusted jerger 's classification as types a , as , b , or c.8 type a and as curves were accepted as no middle ear effusion while type b , type c , and type as as predicting of middle ear effusion . tympanometry results were used to diagnose eom .
we performed statistical analyses by using spss 22.0 operating program ( license no : 10240642 ) .
we used the pearson chi - square test and fisher - freeman - halton test . each analysis
the study included 589 patients that underwent fiber optic examination of the nasopharynx done with an endoscope .
adenoid vegetation was present in 58 patients ( 9.8% ) and was not detected in 531 patients ( 90.2% ) .
we detected grade 2 adenoid vegetation in 22 of 58 patients ( 38% ) , 18 ( 31% ) had grade 3 , 18 ( 31% ) had grade 4 adenoid vegetation ( fig .
we obtained type a tympanogram for 47 ( 81% ) of the 58 patients with adenoid vegetation , 6 ( 10.3% ) were type b , and 5 ( 8.6% ) type c. we found serous otitis media frequency in the 58 patients with adenoid vegetation to be 18.9% . 

, we obtained type a tympanogram in 448 patients without adenoid vegetation ( 84.4% ) , type b in 19 ( 3.6% ) , and type c in 64 ( 12% ) patients .
we found the incidence rate of serous otitis media in 531 patients without adenoid vegetation to be 15.6% .
table 1 shows the frequency of adenoid vegetation in patients with and without serous otitis media .
when 58 patients with adenoid vegetation compared with 538 patients without adenoid vegetation about serous otitis media , the frequency was not statistically significant ( p  >  0.05 ) .
relation between age range and eom is not found statistically meaningful ( p  >  0.05 ) .
ome may be spontaneously due to poor eustachian tube function , or as an inflammatory response following acute otitis media .
the importance of understanding the ome condition stems from its high prevalence with effusion , difficulties in identifying and assessing duration , increased risk of conductive hearing loss , potential impact on linguistic communication and cognition , and significant practice variations in management.9 when the diagnosis of otitis media with effusion is uncertain , tympanometry or acoustic reflectometry should be measured as an adjunct to pneumatic otoscopy.10 
 11 in our study , an otorhinolaryngologist examined all children on both ears using an otoscope and tested them with tympanometry .
we investigated the frequency of serous otitis media in patients referred to the pediatric clinic between 316 years of age without any active ear , nose , and throat complaints in our study .
williamson et al studied 856 children aged 5 to 8 years from four south west hampshire schools , which underwent an examination in three - years time by tympanometry , a method used to detect otitis media with effusion ( > 90% specificity and sensitivity ) performed once per school term .
they recorded normal ears in 54.9% of children with 27% showing evidence of middle ear effusion.12 our study found similar results , albeit in smaller numbers : 94 of 589 patients ( 15.9% ) presented serous otitis media
. the lower ratio of serous otitis media in our study may be due to the fact that none of the patients included in this study had active otolaryngologic complaints .
tomonaga et al studied nasopharyngeal bacterial flora in 259 children with otitis media with effusion .
the results of this study suggest that adenoid vegetation plays an important role in the etiology of otitis media with effusion.13 sanli et al performed that ear , nose , and throat examination and a questionnaire on 1,165 children from four randomly selected schools .
there was significant relation between otitis media with effusion and adenoid vegetation ( p  <  0.01).14 the incidence of serous otitis media in 58 patients with adenoid vegetation was similar to the rate of 18.9% in this study .
the incidence of serous otitis media is 15.6% in the 531 patients without adenoid vegetation and the comparison of 58 patients with adenoid vegetation and 538 without adenoid vegetation considering serous otitis media is not statistically meaningful ( p  >  0.05 ) .
this may be because adenoid vegetation does not have much impact on serous otitis media ; moreover , the number of the patients with adenoid vegetation ( n  =  58 ) is less than the number of the patients without adenoid vegetation ( n  =  531 ) , which leads us to consider the reason insufficient .
screening surveys of children in good health ranging in age from infants to age five years show a 15% to 40% prevalence of middle - ear effusion.6 
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 21 among children examined at normal intervals for one year , 50% to 60% of child care center attendees17 and 25% of school - aged children22 had otitis media with effusion at some time during the examination period , with elevated incidence during the winter months .
population - based screening has not impacted short - term language outcomes18 and we have not assessed its long - term effects in a randomized clinical trial .
thus , the recommendation for screening is based not only on the ability to identify otitis media with effusion but , more importantly , on a lack of incontrovertible benefits from treating children identified as such that exceed the auspicious natural history of the disease
. the new zealand health technology assessment23 could not determine if preschool screening for otitis media with effusion was effective .
more recently , the canadian task force on preventive health care24 studied that there was insufficient evidence to recommend including or excluding regular early screening for otitis media with effusion .
although screening for otitis media with effusion is not inherently harmful , potential risks include erroneous diagnoses , overtreating self - limited disease , parental fear , and the costs of screening and excessive treatment .
population - based screening is suitable for conditions that are ordinary , can be found by a sensitive and specific test , and provide the advantages stemming from early detection and treatment.25 the first two requirements are fulfilled by otitis media with effusion , which affects up to 80% of children by school entry4 
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 12 and can be easily screened with tympanometry .
kucur et al reported that the prevalence of ome among 712-year - old schoolchildren in erzurum ( n  =  26 ) .
local data provide a population specific standard and can be used in healthcare planning.26 complications of ome especially occur if the disease is not recognized in its early stages and/or treated accordingly .
chronic otitis media , adhesive otitis media , retraction pockets , and tympanosclerosis are the most common complications of chronic ome .
when permanent hearing loss develops due to complications , it may lead to impairment in development of speech and language.27 

as a result , we believe it is possible to detect serous otitis media in children without any ear , nose , and throat complaints with adenoid vegetation . therefore , pediatric patients should undergo screening at regular intervals . the scan time and frequency terms
 
 introduction  otitis media with effusion is the fluid in the middle ear with no signs or symptoms of acute ear infection . 
 
 objective  this study aims to research the frequency of serous otitis media in patients referred to the pediatric clinic between 316 years of age without any active ear , nose , and throat complaints . 
 
 methods  this study included 589 children patients ( 280 boys , 309 girls ; mean age : 9.42 ; range 316 ) who were administered to the pediatric clinic without otolaryngologic complaints . patients underwent examination with flexible nasopharyngoscopy for adenoid hypertrophy . 
 an otorhinolaryngologist examined all children on both ears using an otoscope and tested with tympanometry . 
 we used tympanometry results to diagnose som . 
 
 results  the study included 589 patients that underwent fiber optic examination of the nasopharynx with an endoscope . 
 adenoid vegetation was present in 58 patients ( 9.8% ) and was not detected in 531 patients ( 90.2% ) . 
 we found serous otitis media in 94 ( 15.9% ) patients . 
 we obtained type a tympanogram in 47 ( 81% ) of 58 patients with adenoid vegetation , 6 ( 10.3% ) type b , and 5 ( 8.6% ) type c. when comparing 58 patients with adenoid vegetation with 538 patients without adenoid vegetation for serous otitis media , the frequency was not statistically significant ( p  >  0.05 ) . 
 
 conclusion  we believe that in children without any ear , nose , and throat complaints , it is possible to detect serous otitis media with adenoid vegetation . 
 thus , pediatric patients should undergo screening at regular intervals . 
Introduction
Objective
Methods
Results
Discussion
Conclusion