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The statement by Drs Wright and Olson that "most of our cases [of acute otitis media] were seen by numerous different pediatric residents, among whom there may not be uniform subjective criteria for making the diagnosis" is the crux of the problem. We agree that such a diagnosis may not be based on uniform subjective criteria. This very fact may be reflected in the ultimate outcome—a higher frequency of fever and otitis media in the Kansas City study. However, in our study, in a private practice setting, all the children were examined by the same pediatrician. Meticulous removal of all gross cerumen and the use of brilliant halogen illumination was the rule; an otoscope head with a rubber gasket on the lens cap ensured a perfect airtight seal.Table 3 of our article shows that of 290 patients who had acute otitis media, a myringotomy, and a culture,
Schwartz RH, Rodriguez WJ, Grundfast K. Otitis Media and Fever-Reply. JAMA. 1982;247(7):978–979. doi:10.1001/jama.1982.03320320018014