Functional tubal therapy for persistent otitis media with effusion in children: myth or evidence?

Otitis media with effusion (OME), a form of inflammatory middle ear disease, is a common reason for young children to visit their family doctor and to have surgery. Tubal dysfunction plays a major role in the pathogenesis. In case of persistent OME, there seems to be a logical rationale for a favourable effect on the tubal dysfunction of a functional active motoric approach combined with behavioral changes (hygiene), and as a consequence for a therapeutic effect on the middle ear disease. The basic principles of this functional treatment are: active ventilation of the middle ear, correction of immature and undesirable deviant mouth habits, increasing swallowing frequency, activating jaw and palate movements, and encouraging the use of chewing gum. The bases for this functional therapy are critically analysed, and it may be concluded that all of these principles rely upon evidence based physiological mechanisms. However, the limited available clinical data from the literature are reviewed, and appear as methodologically weak. The results of an own prospective randomized pilot study comparing functional treatment with watchful waiting may be considered encouraging, since a borderline significance level was reached with a small amount of subjects.