Obesity may contribute to OME through the following mechanisms: alterations in cytokine levels, such as IL-6, TNF-α, and fibrinogen activator inhibitor-1 (FAI-1); alterations in host immunity; induction of gastroesophageal reflux; and alterations in pharyngeal tube structure [22–24]. This evidence concerns the gene TNF and obesity due to melanocortin 4 receptor deficiency.