Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
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
Gillespie MB. Recurrent Otitis Media in ChildrenRecurrent Otitis Media in Children. JAMA. 2003;289(11):1382-1385. doi:10.1001/jama.289.11.1382-a