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March 19, 2003

Recurrent Otitis Media in ChildrenRecurrent Otitis Media in Children

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(11):1382-1385. doi:10.1001/jama.289.11.1382-a

To the Editor: Dr Paradise1 argued against use of tympanostomy tubes in a patient with recurrent otitis media. This appears to contradict his prior statements.2

Experimental models and clinical evidence support a role of eustachian tube dysfunction in the pathogenesis of otitis media. Middle ear ventilation is currently the only treatment strategy that addresses this underlying pathophysiology. Although ventilation tubes carry a small risk of persistent tympanic membrane perforation, the association with atelectasis, retraction pockets, and cholesteatoma noted by Paradise is confounded by the presence of chronic eustachian tube dysfunction in these patients. Otorrhea is a sign of recurrent infection and is not a complication of tympanostomy tubes in most instances.3 Conversely, tympanostomy tubes result in infections that are typically less symptomatic and that quickly resolve with the use of broad-spectrum topical therapy, such as quinolones, that addresses resistant organisms with minimal risk of systemic adverse effects.4

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