Allergic factors are important, but not the only etiologic force in middle ear effusion. Nor do bacterial and viral infections, nasopharyngeal mass lesions, neuromuscular or regional anatomic abnormalities rank as sole etiologic factors. Some children have multiple components to their problem that requires specific identification before a workable approach to management can be tailored for each of them. Identification and management of allergic factos requires special skills and a greater commitment of time. Yet the marked increase in total yield when allergic techniques are added to the armamentarium of the otolaryngologist make these factors both worthwhile and satisfying.
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