In Reply.—Thank you for your comment on our article.1 Why systemic steroids are effective for some, but not all, persistent middle-ear effusions is unknown. Inhalant allergies were present in 3% to 13% of children included in our meta-analysis, but sufficient information was not available to assess their impact on outcome. None of the studies we reviewed included tests for food allergy. Although it is reasonable to expect that food allergies may contribute to tubal and peritubal edema, and hence to otitis media with effusion, we are unaware of any controlled study supporting such an association. Whereas it would be desirable to cure chronic middle-ear effusions without steroids, surgery, or antimicrobials, at present these are the only therapeutic options for which efficacy has been convincingly demonstrated.
ROSENFELD RM, MANDEL EM, BLUESTONE CD. Otitis Media-Reply. Arch Otolaryngol Head Neck Surg. 1992;118(4):449. doi:10.1001/archotol.1992.01880040117027