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Review Article | DOI: https://doi.org/10.31579/2690-4861/1041
Department of Otorhinolaryngology, Federal University of Sao Paulo, Sao Paulo, Brazil.
*Corresponding Author: Manoel de Nobrega, Department of Otorhinolaryngology, Federal University of Sao Paulo, Sao Paulo, Brazil. mnobrega@terra.com.br and ORCID: 0000-0002-1342-633X
Citation: Manoel de Nobrega, (2026), Otitis Media with Effusion in Children: A Review of Pathophysiology, Risk Factors, and Management, International Journal of Clinical Case Reports and Reviews, 34(1); DOI:10.31579/2690-4861/1041
Copyright: © 2026, Manoel de Nobrega. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 27 January 2026 | Accepted: 06 February 2026 | Published: 13 February 2026
Keywords: otitis media with effusion; children; ventilation tubes
Otitis Media with Effusion (OME) is characterized by the presence of middle ear fluid without signs of acute infection and is primarily associated with Eustachian tube (ET) dysfunction. In children, ET immaturity, impaired middle ear ventilation, and inflammatory conditions contribute to negative pressure and fluid accumulation. Younger age, particularly under seven years, is a major risk factor due to anatomical and immunological immaturity. Additional predisposing factors include bottle feeding, pacifier use, daycare attendance, exposure to secondhand smoke, allergic rhinitis, and recurrent upper respiratory tract infections.
Diagnosis is often subtle and relies on otoscopy, tympanometry, and audiological assessment. Tympanometry remains the gold standard for detecting effusion, while audiometry typically demonstrates fluctuating conductive hearing loss, predominantly affecting low frequencies. OME may negatively impact speech and language development, academic performance, and behavior, particularly when hearing loss is persistent or asymmetric.
Most cases resolve spontaneously within three months; therefore, initial management focuses on observation, hearing monitoring, and modification of risk factors. Surgical intervention with ventilation tube insertion is recommended for persistent OME lasting longer than three months when associated with significant hearing loss or documented speech and learning difficulties. Early identification and appropriate management are essential to prevent long-term auditory, cognitive, and linguistic consequences.
Otitis media with effusion (OME) is defined as the presence of fluid within the middle ear (ME) in the absence of local or systemic signs of acute infection typically associated with acute otitis media (AOM), such as otalgia, fever, or overt inflammatory changes [1–5]. In this condition, fluid accumulates in the tympanic cavity without the characteristic clinical features of active infection, often resulting in a subtle or asymptomatic presentation. OME is widely regarded as the maximal expression of Eustachian tube (ET) dysfunction, as the likelihood of effusion formation increases proportionally with the degree of negative pressure within the ME [3].
Children younger than seven years are at increased risk for developing both OME and AOM, primarily due to immaturity of the immune system and ET dysfunction [6]. Following an episode of AOM, persistence of ME effusion is common, with fluid present in approximately 70% of cases after two weeks, 40?ter one month, 20?ter two months, and 10?ter three months, until normal ME aeration is restored [7]. Immunological immaturity plays a central role in this susceptibility. Humoral immunity reaches near adult levels for immunoglobulin G (IgG) by approximately five to six years of age, whereas other antibody classes, including IgM and IgA, mature later, typically between 10 and 12 years [8]. Cell-mediated immunity, including T-cell function, stabilizes around six to seven years of age, although T-cell receptor diversity continues to develop throughout adolescence [9]. In addition, mucosal immunity—particularly secretory IgA—may not reach full maturity until late childhood, contributing to prolonged inflammatory responses and delayed resolution of ME effusion [10].
There is substantial clinical and experimental evidence supporting the critical role of ET function in maintaining normal hearing and ME homeostasis, and ET dysfunction is recognized as a key causal factor in the development of otitis media [11]. Gas exchange across the ME mucosa is the primary mechanism regulating ME pressure, while the ET acts as a dynamic valve, releasing excessive positive pressure and actively equalizing negative pressure through muscular opening [12]. Inflammatory processes that alter mucosal thickness, vascular permeability, and blood flow impair gas diffusion across the ME mucosa, thereby disrupting pressure regulation and promoting effusion formation [10,13].
Failure of the ET to adequately perform its essential functions—pressure regulation, secretion clearance, and protection of the ME—leads to the development of negative ME pressure due to insufficient ventilation [13]. This negative pressure promotes transudation of intravascular fluid into the interstitial space and subsequently into the ME lumen, a process strongly associated with effusion formation [14]. However, effusion may also develop in the absence of markedly negative pressure, particularly following inflammatory insults mediated by pro-inflammatory cytokines [20]. Persistent negative pressure and chronic ET dysfunction may result in tympanic membrane (TM) retraction, ME atelectasis, and, in advanced cases, TM perforation with epithelial migration and cholesteatoma formation [15].
This progressive pathological sequence is described by the Continuum Theory, which proposes that otitis media evolves along a continuous spectrum from serous or purulent inflammation to seromucoid, mucoid, and ultimately chronic disease if spontaneous resolution or effective treatment does not occur [15]. Structural and histological changes in the epithelial and subepithelial layers of the ME are believed to drive this progression, with luminal effusion caused by sustained negative pressure representing one of the earliest markers of disease [21]. From this point onward, the subepithelium and later the epithelium respond to the adverse environment with histological modifications that may become irreversible and define the long-term pathological course [15].
Anatomical characteristics of the pediatric ET further contribute to this vulnerability. The ET undergoes significant growth throughout childhood, with a linear increase in cartilage volume of approximately 20 mm³ per year until early adulthood [16]. Adult ET length is nearly twice that observed before seven years of age [17]. In young children, the ET is also more horizontally oriented, with angles as low as 10°, compared with 30–45° in adults, facilitating reflux of nasopharyngeal secretions and pathogens into the ME [18]. This anatomical configuration reduces the mechanical efficiency of the tensor veli palatini muscle and increases susceptibility to ME inflammation and infection. Additional features—including a narrower ET lumen, higher cartilage cell density with reduced elastin content, smaller Ostmann’s fat pad, and increased mucosal folds—further compromise ET function in children and predispose them to ME pathology [17].
Chronic inflammatory conditions such as allergic disease, laryngopharyngeal reflux, or incomplete resolution of AOM may perpetuate ET dysfunction, maintaining a negative pressure environment within the ME [18]. Prolonged ET dysfunction promotes continued transudation of fluid from the mucosa and movement of intravascular fluid into the ME lumen, thereby sustaining effusion and increasing the risk of chronic disease [19].
Predisposing Factors for Acute Otitis Media and Progression to Otitis Media with Effusion
Several environmental, behavioral, and inflammatory factors predispose children to acute otitis media (AOM) and may contribute to the persistence of middle ear effusion and progression to otitis media with effusion (OME). Artificial feeding is a well-established risk factor, as infants who are not breastfed or are exclusively bottle-fed present a higher incidence of both AOM and OME [21,22]. Bottle-feeding is commonly associated with a more horizontal feeding position, which facilitates reflux of milk into the Eustachian tube (ET), increasing the likelihood of fluid and pathogen entry into the middle ear. In addition, the absence of protective immune components found in breast milk—particularly secretory immunoglobulin A (IgA)—reduces mucosal defense against respiratory and middle ear infections [22].
Oral habits, including pacifier use and digit sucking, have been associated with an increased risk of AOM through their impact on oropharyngeal pressure dynamics and ET function [23]. Pacifier use is linked to a 20–30% higher risk of AOM and may promote disease through several mechanisms, including bacterial contamination of pacifier surfaces, which favors nasopharyngeal colonization by pathogens such as Streptococcus pneumoniae, and reduced spontaneous swallowing, a physiological trigger for ET opening and middle ear pressure equalization [23]. Digit sucking may exert similar effects, although the available evidence supporting this association is less robust [23].
Early exposure to respiratory pathogens represents another important risk factor. Children attending daycare centers or group childcare settings experience two to three times more episodes of AOM during their first year of life compared with those cared for at home [24]. This increased susceptibility is closely related to group size and higher rates of transmission of common pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, leading to recurrent upper respiratory tract infections and sustained nasopharyngeal colonization [24].
Passive exposure to tobacco smoke is strongly associated with both AOM and OME, increasing the risk by approximately 30–50% [25]. Secondhand smoke impairs ciliary function within the ET, compromising secretion clearance and middle ear ventilation, while simultaneously increasing nasopharyngeal colonization by pathogenic bacteria. In addition, tobacco smoke exacerbates inflammation of the respiratory mucosa, creating a favorable environment for recurrent infection and persistent effusion [25].
Inflammatory conditions of the upper airway, particularly allergic rhinitis, play a significant role in ET dysfunction and effusion development. Nasopharyngeal mucosal edema caused by allergic inflammation can obstruct the ET, impair middle ear ventilation, and promote fluid accumulation [26]. Children with allergic rhinitis have an approximately 1.8- to 2-fold increased risk of developing OME, especially in cases of persistent disease, due to chronic nasopharyngeal inflammation and ongoing ET dysfunction [26,27]. Chronic nasal obstruction, frequently associated with adenoid hypertrophy, may also lead to habitual mouth breathing, which alters oropharyngeal pressure patterns and further compromises ET function [29].
The association between swimming and OME remains controversial. Some evidence suggests that frequent exposure to chlorinated pool water may irritate the upper airways, particularly in atopic children, predisposing them to nasopharyngeal inflammation and subsequent ET dysfunction [28]. Finally, recurrent viral upper respiratory infections, including those caused by respiratory syncytial virus and rhinovirus, induce inflammation of the ET mucosa and facilitate secondary bacterial colonization of the nasopharynx, thereby increasing the risk of OME development [30].
Middle Ear Ventilation and Diagnostic Assessment
Middle ear (ME) ventilation is a dynamic process, as ME aeration conditions fluctuate over time rather than remaining constant. Accurate assessment of these variations is essential for the diagnosis and monitoring of otitis media with effusion (OME), particularly in children, in whom clinical manifestations are often subtle [3].
Clinical evaluation alone is frequently insufficient for diagnosing OME. The condition predominantly affects children under seven to eight years of age and is commonly associated with nonspecific symptoms, including attention and concentration difficulties, learning problems, hyperactivity, and behavioral changes. Subjective auditory complaints such as hearing loss, aural fullness, or tinnitus are uncommon in this age group [3]. Potential consequences of persistent OME include delayed speech and language development, articulation errors, and poor academic performance, underscoring the importance of objective assessment methods [3].
Otoscopy remains an essential component of the diagnostic evaluation, allowing visual inspection of the tympanic membrane (TM). Conventional otoscopy, pneumatic otoscopy, fiber-optic or video otoscopy, and microscopic examination may all be used to assess TM appearance and mobility. In OME, the TM typically appears opaque and thickened, with an absent or diffuse light reflex; it may be retracted and may show air bubbles or fluid levels ranging from clear to yellow or rust-colored [3]. Pneumatic otoscopy can provide indirect information regarding TM and ossicular chain mobility. However, otoscopy is inherently subjective and does not allow precise determination of ME pressure. Regardless of the technique used, otoscopic findings can only suggest normal or abnormal ME status and cannot accurately quantify ME aeration [3].
Audiological assessment is therefore a critical component of OME evaluation and should be tailored to the child’s age and level of cooperation. Whenever possible, testing should be performed by an experienced speech-language pathologist or audiologist with expertise in pediatric assessment. Behavioral hearing evaluation may be used in younger children, while conditioned audiometry, speech detection thresholds, and air- and bone-conduction threshold testing with headphones can be performed in older children, including those as young as three to four years of age. Even small air–bone gaps should be carefully interpreted, as they may reflect clinically significant conductive hearing loss associated with ME effusion [3].
Among audiological tools, acoustic immittance testing (tympanometry) plays a central role. Tympanometry is a noninvasive, objective, and rapid examination and may be the only feasible test in very young children. It provides quantitative information about ME aeration by measuring ME pressure. Normal aeration is characterized by a Type A tympanometric curve (0 to −100 daPa), negative ME pressure by a Type C curve (≤ −100 daPa), and the presence of effusion by a flat Type B curve, typically observed at pressures between −400 and −600 daPa [31]. By translating otoscopic impressions into numerical values, tympanometry serves as both a diagnostic and monitoring tool. Serial tympanometric measurements allow precise assessment of disease progression or resolution by documenting whether ME aeration remains stable, deteriorates, or improves over time [31].
Assessment by a speech-language pathologist is also fundamental, as it evaluates speech and language acquisition and helps guide therapeutic decision-making. A normal speech and language evaluation may suggest recent-onset OME that has not yet caused developmental impairment, allowing for a more conservative medical approach. In contrast, abnormal findings indicate interference with learning and communication processes and warrant timely intervention to minimize long-term consequences. Optimal hearing is critical for oral language acquisition, and early childhood represents a sensitive period during which auditory “windows of opportunity” open and close rapidly, making early diagnosis and appropriate management essential [31].
Prevention Priorities in Otitis Media with Effusion
Preventive strategies in OME focus on minimizing both local middle ear damage and the functional consequences of auditory impairment. Persistent negative ME pressure may lead to structural alterations, including horizontalization of the malleus handle, retraction pocket formation, mucosal changes within the ME, and, in advanced cases, cholesteatoma development secondary to TM retraction. Although less common, long-standing disease may also contribute to sensorineural hearing loss [31].
Equally important is the prevention of auditory dysfunction caused by sound attenuation and distortion. In OME, negative ME pressure is not static but fluctuates over time, resulting in variable and unpredictable hearing levels. For children in critical stages of oral language development, this auditory instability can be particularly harmful, leading to delayed speech and language acquisition, restricted vocabulary growth, and poor academic performance. Psychosocial and behavioral consequences may also emerge, including social withdrawal, reduced auditory attention, difficulty following instructions, poor concentration, and compensatory hyperactivity or restlessness. In some cases, motor coordination problems, such as clumsiness or frequent falls, may occur, potentially related to vestibular dysfunction or attentional deficits [31].
Severity of Hearing Loss and Psychosocial Impact in Otitis Media with Effusion
The hearing loss associated with otitis media with effusion (OME) is typically conductive, bilateral, and of mild to moderate degree, with average thresholds ranging from 18 to 35 dB HL at frequencies critical for speech perception [32]. Although often labeled as “mild,” this level of hearing loss has clinically significant consequences, particularly in noisy domestic and educational environments. Children with OME frequently demonstrate impaired word recognition, especially in acoustically challenging settings such as classrooms, where background noise and reverberation are common [32].
Between the ages of 6 and 11 years, children with hearing thresholds within this range show significantly poorer cognitive, linguistic, and reading skills compared with peers who have better hearing sensitivity [33]. These findings highlight that the functional impact of OME-related hearing loss extends well beyond simple audibility deficits.
Functional Impact According to Degree and Configuration of Hearing Loss
Minimal hearing loss (16–25 dB HL) is associated with difficulty perceiving distant or soft speech, such as a teacher’s voice at distances greater than one meter. In noisy classrooms, this degree of loss may result in the omission of approximately 10% of the speech signal, which is particularly detrimental during early school years when verbal instruction predominates [32].
Mild hearing loss (26–40 dB HL) leads to more pronounced speech perception deficits, with losses of approximately 25–40% of speech information at thresholds around 30 dB HL, increasing to as much as 50% at thresholds between 35 and 40 dB HL. High-frequency consonants are especially affected. In the absence of amplification, children with mild hearing loss often struggle during group discussions, particularly when speakers are not facing them or when the listening environment is reverberant or noisy [32].
Unilateral hearing loss, characterized by normal hearing in one ear and minimal to mild loss in the other, also carries important functional consequences. These children experience deficits in sound localization and significant difficulty understanding speech in noise, particularly in classrooms where the signal of interest may originate from different directions. Speech presented on the affected side may be poorly detected even at normal conversational levels [32].
Fluctuating Conductive Hearing Loss in OME
A defining characteristic of OME-related hearing loss is its fluctuation over time. Negative middle ear (ME) pressure resulting from Eustachian tube dysfunction leads to hearing loss that varies in severity, improving or worsening as ME aeration changes. In addition to attenuation, negative pressure causes sound distortion, which also fluctuates and further compromises speech perception. Importantly, negative ME pressure invariably produces some degree of conductive hearing loss [34].
Classic experimental work by Feldmann [34] demonstrated that a negative ME pressure of approximately −100 daPa (or −100 mmH₂O) results in a conductive hearing loss of about 5 to 10 dB, predominantly affecting low frequencies below 1 kHz. This occurs due to reduced efficiency of sound transmission through the ossicular chain. When ME pressure reaches −400 daPa, hearing loss becomes more pronounced, potentially ranging from 15 to 25 dB, again mainly at low frequencies. At this level, increased tension of the tympanic membrane and stiffness of the tympano-ossicular system further impair sound transmission [35].
Clinically, a child with bilateral hearing thresholds around 28 dB due to OME may struggle to hear soft speech, barely perceive normal conversational speech, or fail to detect salient sounds such as a crying infant [35]. These examples illustrate that the real-life impact of “mild” conductive hearing loss can be substantial.
Developmental and Cognitive Consequences
The functional impact of mild hearing loss is consistently underestimated. Children aged 6 to 11 years with pure-tone averages between 15 and 30 dB HL demonstrate significantly poorer cognitive, linguistic, and reading abilities than children with better hearing thresholds [36]. The degree of hearing loss associated with OME may range from no measurable loss to moderate loss, reaching levels as high as 55 dB HL in some cases [36]. Although the average hearing loss in children with OME is approximately 28 dB, nearly 20% exhibit thresholds of 35 dB or greater [37,38].
The first and second years of life represent critical periods for speech, language, and cognitive development. Any degree of hearing loss during these sensitive windows may have long-lasting consequences, including poorer academic performance later in childhood [37–39]. Fluctuating hearing loss caused by OME during the first year of life degrades the quality of auditory input, particularly speech signals. Early auditory deprivation may lead to altered perception of the linguistic code, resulting in inadequate phonological representation and impaired early language acquisition. Additional consequences include atypical auditory electrophysiological and psychoacoustic processing, attention and behavioral difficulties, deficits in auditory selective attention, higher-order auditory processing disorders, and reading difficulties. These effects may be further compounded by genetic susceptibility and environmental factors such as parental interaction and stimulation [37,38].
Psychosocial and Neurodevelopmental Effects
From a neuropsychological perspective, Chase [41] evaluated infants with otitis media and observed their interactions with caregivers. The study demonstrated that children with more frequent episodes of otitis media were less attentive, less responsive during structured parent–child interactions, and more likely to exhibit irregular sleep patterns, feeding difficulties, and delayed sphincter control. Parents were also affected, experiencing poorer sleep quality, which reduced their capacity to provide structured learning activities and to sustain their child’s attention during interactions.
Longitudinal data from Hall, Munro, and Heron [42], derived from the Avon Longitudinal Study of Parents and Children (ALSPAC), further elucidate the developmental impact of OME. This large cohort study assessed developmental changes in speech recognition thresholds (SRT) between 2 and 5 years of age in children with different otitis media statuses. In children without otitis media, mean SRT improved by approximately 5 dB between 31 and 43 months and between 31 and 61 months, reaching an average of 23 dB at five years of age and improving further to a mean adult SRT of 18.6 dB. The total gain in SRT from age two to adulthood was approximately 11 dB [42].
Children with unilateral OME demonstrated SRTs that were 4 to 5 dB worse than those of children without otitis media, likely reflecting the loss of binaural hearing advantages, which normally confer an approximate 3 dB benefit for speech perception. In contrast, children with bilateral OME showed significantly impaired SRTs at all ages (p < 0>
Surgical Management: Ventilation Tube Insertion
Ventilation tube (VT) insertion remains the most widely used surgical intervention for otitis media with effusion (OME) in children, particularly in cases of persistent disease associated with hearing loss or developmental risk. Evidence consistently demonstrates that VT placement provides meaningful short-term benefits in middle ear aeration, hearing thresholds, and quality of life.
The landmark study by Hellström, Groth, Jørgensen et al. (2011) [43] showed that VT insertion is associated with significant short-term improvements in children’s health-related quality of life. Meta-analytic data indicate that VT placement reduces the prevalence of OME by approximately 32% during the first postoperative year and improves average hearing thresholds by 5 to 12 dB [44]. In addition, a non-randomized study demonstrated improved caregiver perception of speech and language outcomes following VT insertion, particularly among children with pre-existing developmental delays, highlighting the potential benefit of early auditory rehabilitation in vulnerable populations [45].
Complications Associated with Ventilation Tubes
Complications related to VT insertion are relatively common but are generally transient or of limited functional significance. The most frequently reported adverse event is otorrhea. Approximately 16% of children experience otorrhea within the first four postoperative weeks, and up to 26?velop otorrhea at some point while the VT remains in place [46]. In the United States, most ventilation tubes remain functional for 8 to 18 months, during which approximately 7% of children experience recurrent otorrhea episodes [46].
A prospective Dutch study reported a higher otorrhea incidence (52%) when children were followed closely and systematically; however, only 3.9% of cases evolved into chronic otorrhea lasting three months or longer. Identified risk factors included younger age, VT placement for recurrent acute otitis media (RAOM), the presence of older siblings in the household, and frequent upper respiratory tract infections [47].
Other complications occur less frequently and include obstruction of the VT lumen (7–10%), granulation tissue formation (approximately 4%), premature tube extrusion (4%), and medial displacement of the VT into the middle ear cavity (<0>
Persistent Tympanic Membrane Perforation
Persistent TM perforation is among the most clinically relevant long-term complications of VT insertion. The reported incidence varies from 1% to 6% of ears following tube extrusion [49]. Large population-based data from a Medicaid cohort demonstrated a persistent perforation rate of approximately 3% seven years after VT insertion [50]. Similarly, O’Neil, Cassidy, Link, and Kerschner [51] reported a 1% rate of persistent perforation after spontaneous VT extrusion, with 2.6% of children requiring surgical removal of retained tubes that failed to extrude spontaneously. Repeat VT insertion and older age at the time of surgery were identified as significant risk factors for persistent perforation. When spontaneous closure does not occur, surgical repair with myringoplasty or tympanoplasty may be required.
Overall, although VT-related complications are not uncommon, the majority are self-limited and must be weighed against the potential benefits of improved hearing, auditory stability, and developmental outcomes in appropriately selected children.
Otitis media with effusion is a highly prevalent pediatric condition primarily resulting from Eustachian tube dysfunction and influenced by anatomical, immunological, and environmental factors. Although often self-limiting, OME may lead to fluctuating conductive hearing loss with significant consequences for speech and language acquisition, academic performance, and psychosocial development, particularly during critical periods of early childhood.
Accurate diagnosis, with emphasis on tympanometry and age-appropriate audiological assessment, is essential to identify children at increased risk of developmental impairment. Management should be individualized, incorporating careful observation, mitigation of modifiable risk factors, and timely surgical intervention when indicated. Tympanotomy with ventilation tube insertion remains an effective treatment for persistent OME associated with documented hearing loss or developmental impact, offering meaningful short-term improvements in hearing and quality of life.
Early recognition and appropriately timed intervention play a pivotal role in minimizing long-term auditory, cognitive, and educational sequelae, underscoring the importance of a structured, evidence-based approach to the management of otitis media with effusion.
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Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
