To the Editor.
—Although the criteria that I have used for recommending tympanostomy tubes are virtually identical to those summarized in the conclusion of the report by Dr Kleinman and colleagues,1 I found much to take issue with in their article. Although they made reference to the likelihood that acute otitis media is overdiagnosed, which I believe to be true based on my experience as an otolaryngologist, they failed to make mention of the equally probable underdiagnosis by primary care physicians of symptomatic chronic otitis media with effusion.The justification for using antimicrobial prophylaxis for recurrent acute otitis media, a treatment that has been shown to reduce the frequency of acute infection in the past, has not been entirely resolved. The relationship between prolonged antibiotic usage and the development of resistant strains of bacteria has not been clarified. While the risks of a surgical procedure such as tympanostomy and
Dankle SK. The Appropriateness of Tympanostomy Tubes for Children. JAMA. 1995;273(9):698. doi:10.1001/jama.1995.03520330027019