الفهرس 
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Abstract
This study was carried out on 50 patients with bilateral COME (100 Ear) not responding to medical treatment, with persistence of MEE for more than 3 months, 17 patients were male and 33 were female with the age ranging between 4 and 14 years, the mean age was (6.08 + 2.3). At the preoperative examination the tympanogram was pathologic (type B) in all cases.
Children who would more likely need prolonged duration ME ventilation were excluded. Examples are those with craniofacial anomalies, severe systemic illness, developmental abnormalities or sensorineural hearing impairment.
Alternative forms of treatment, as well as the risks and benefits of MMC therapy, were clearly described. Informed consent was obtained before any procedure.
Fifty patient (100 ears) were subjected to myringotomy with Grommet tube insertion in the left ear and knife radial myringotomy in the right ear with intraoperative application of mitomycin C (MMC), the final distribution of ear were:
• Group (A) 50ears: They were subjected to radial tympanotomy to about 2 mm wide and placement of VT.
• Group (B) 50 ears: subjected to radial tympanotomy to about 2 mm wide and insertion of a piece of cotton embedded in MMC solution at the concentration of 0.5 mg/mL in the incision for five minutes.
Adenoidectomy was performed in 32 children (64 ears) with a history of adenoid hypertrophy and Tonsillectomy was performed in children with a history of recurrent tonsillitis.
All patients were followed up for 6 months 0
The results of this study show that In the MMC group the closure of TM took place 14-21days.
At the end of the 6 months observation period resolution in the 50 ears undergoing myringotomies with Mitomycin C application, 12 ears (24%) showed no clinical or tympanometric signs of otitis media with effusion compare to 41ear (82%) of the 50 ear undergoing myringotomies with tube insertion.
As regard to occurrence of otorrhea there was a highly significant difference between myringotomy with VT group and myringotomy with MMC groups (p< 0.01) , as the otorrhea occurred only in myringotomy with VT group .
In the MMC group all tympanostomies healed with no residual perforation, but in VT group 4 ears (8%) showed permanent perforation.
None of the patients developed inner ear disorders like sensorineural hearing loss or vestibular dysfunction after the intervention.
The results of this study show that MMC application on myringotomy site is safe but not effective procedure that can reduce the frequency of tympanostomy tube insertion for treatment of COME.