To the Editor.
—The uncontrolled study by Dr Kleinman and colleagues1 concludes that less than 50% of the tympanostomy tubes placed for recurrent or persistent otitis media were appropriate. The data obtained were all retrospective and taken from the office charts of presumably busy practitioners. I suggest an alternate conclusion. This sort of physician documentation does not produce valid clinical research studies.A good otolaryngologist or pediatrician is generally busy, and it is far better to devote one's time to examining the child and talking with the parents than it is to write in the chart. An astute otolaryngologist listens to the referring pediatrician, listens to the parents, and examines the child. From all of this, a clinical decision is made. The diagnosis and the treatment alternatives are then presented to the parents, who then make a decision to have tympanostomy tubes placed. The entirety and complexity of this
Davidson TM. The Appropriateness of Tympanostomy Tubes for Children. JAMA. 1995;273(9):698. doi:10.1001/jama.1995.03520330027020