الفهرس 
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Abstract
Tubotympanic disease, still constitutes a major public health problem and is one of the most common ear diseases. It is the commonest cause of persistent mild to moderate hearing impairment not only in children but also in young adults.
It is commonly a disease of the developing world with malnutrition, over-crowding, substandard hygiene, frequent upper respiratory tract infections and under-resourced health care (all linked to low socio-economic status) listed as risk factors.
It is found that the incidence of tubotympanic disease has been reported to depend on socioeconomic factors, and it is significantly higher where social conditions are poor. During recent decades, the incidence has dramatically declined due to improvement in the socio-economic status, health education and health facilities.
Our study includes published medical articles concerning the relation between low socioeconomic conditions and occurrence of tubotympanic disease. The search will be limited to articles published in English language on Pubmed.
Our results in this study as demonstrated in the previously mentioned forrest- plot showed that, there is strong evidence of association between many socioeconomic factors and prevalence of tubotympanic disease, but degree of association between each risk factor and prevalence of tubotympanic disease differs according to this factor.
Most of the studies found are excluded, only 4 articles were included. We analyzed the 4 articles selected according to the previously selected inclusion criteria and its analysis using meta analytic software (RevMan) version 5.1.7.
The frist study (Cambon et al., 1965) is a randomized controlled study which ensures that, there is significant association between each of poor social condions, positive family history for tubotympanic disease and repeated URTI and occurrence of tubotympanic disease.
The second study (Van der Veen et al., 2006) is a randomized controlled study which ensures that, there is significant association between both low maternal education and repeated URTI and occurrence of tubotympanic disease, while association between each of younger age, male gender and overcrowded housing and occurrence of tubotympanic disease is insignificant.
The third study (Adoga et al., 2010) is a prospective clinical study which ensures that, there is insignificant association between both younger age and male gender and occurrence of tubotympanic disease, while association between unemployment and occurrence of tubotympanic disease is significant.
The fourth study (Lasisi et al., 2008) is a prospective clinical study which ensures that, there is insignificant association between both repeated URTI and male gender and occurrence of tubotympanic disease, while association between both low social class and overcrowded housing and occurrence of tubotympanic disease is significant.
We also, discuss the other non randomized and non comparative studies to form an idea about the relation between low socioeconomic conditions and occurrence of tubotympanic disease. Data available ensure the need for more randomized controlled trials to determine more accurate results.
Finally, we can say that there are many risk factors which contribute in etiology and occurrence of tubotympanic disease but, the most important factor is the socioeconomic status. There is an evidence of a strong relation between low socioeconomic conditions including low social income, malnutrition, substandard hygiene, frequent upper respiratory tract infections and under-resourced health care and occurrence of tubotympanic disease. Improvement in socio-economic status, health education and health facilities will be helpful in reducing the prevalence of tubotympanic disease.