June 1990


Author Affiliations

Virginia Beach, Va

Arch Otolaryngol Head Neck Surg. 1990;116(6):741. doi:10.1001/archotol.1990.01870060099022

To the Editor.—Dr David Austin1 is to be commended for his courageous second look at adenotonsillectomy visa-vis chronic serous otitis media/recurrent bacterial otitis media. A number of senior otolaryngologists have, for decades, advocated an adenotonsillectomy approach to recurrent bacterial otitis media. Their work was, unfortunately, drowned out by the rush to tympanostomy tube placement. In a way, the tympanostomy tube with its complications of otorrhea, extrusion, cholesterol pearl formation, and persistent perforations represents a double-edged sword. Crying, traumatized, unhappy pediatric otologic patients have "enslaved" two generations of otolaryngologists.

Adenotonsillectomy has proven to be the procedure of choice for the following conditions:

  • upper airway compromise2-4

  • obstructive sleep apnea2,5,6

  • upper airway compromise with secondary cor pulmonale2,7

  • aberrant dentofacial development8-10

  • recurrent bacterial adenotonsillitis

  • chronic serous otitis media/bacterial otitis media

  • some cases of enuresis

  • excessive daytime sleepiness3

  • retarded intellectual and physical growth3

It is indeed unfortunate that third-party health insurance carriers pay so poorly for such a wonderful procedure. When an

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