To the Editor.
—Dr Kleinman and colleagues1 report that 41% of tympanostomy tube insertions are appropriate. This astonishing conclusion translates in 1994 into some 600 000 unnecessary pediatric surgical procedures in the United States at a cost of $1.2 billion. Kleinman et al, without any scientific evidence, recommend that surgery not be performed "until a perfusion persists through a course of antibiotics and at least 90 days of watchful waiting" and that antibiotic prophylaxis be used for recurrent otitis media. They do not cite their own abstract,2 which reported that of 3970 children proposed for tympanostomy tube surgery, each child was treated unsuccessfully with an average 4.3 courses of antibiotics. The data collected by Kleinman et al indicate the ineffectiveness of ubiquitous antibiotic treatment. The argument of Kleinman et al, reduced to a nutshell, is that the other 59% of children should also be aggressively and unsuccessfully treated
Cantekin EI. The Appropriateness of Tympanostomy Tubes for Children. JAMA. 1995;273(9):697–698. doi:10.1001/jama.1995.03520330027017
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