IL-4 was identified in the middle ear effusions of children with persistent OME 109 and in atopic children with OME undergoing myringotomy and ventilation tube placement. 110 The cytokine analysis of effusions showed a higher mean level of IL-4 in the allergy-positive group compared with the allergynegative group 109 and a higher percentage of cells expressing IL-4 in atopic patients with OME compared with that seen in non-atopic patients. 110 A higher level of IL-4 in effusions correlated with predominance of T lymphocytes, which was the sign of chronic inflammation and was also related to the atopic background of patients with OME. 110 In effusions of non-atopic patients, the level of IL-4 was lower and the predominance of neutrophils 109 demonstrated signs of an acute inflammatory response.