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March 23, 1984

Risk Factors for Persistent Middle-Ear Effusions-Reply

JAMA. 1984;251(12):1556. doi:10.1001/jama.1984.03340360024022

In Reply.—  The letter by Rogers et al details their objections to our analysis of the risk factors for persistent middle ear effusions. They claim that because household cigarette smoke exposure and an atopic history seem to be strongly related to nasal congestion, which in turn is strongly related to PMEE, the apparent associations of PMEE with cigarette smoke exposures and atopy are only artifactual. They support their assertion by noting that, when the data from Table 2 are adjusted for the presence of nasal congestion, there is then no difference in the proportion of cases and controls who were atopic or exposed to cigarette smoke.However, we believe that it is inappropriate to control for nasal congestion when assessing the risk for PMEE associated with exposures to household cigarette smoke and with atopy. This is because of our feeling that nasal congestion should not be considered as a confounder