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The general tone in Dr
Arenberg's letter is such that we would be inclined not to enter into a discussion. However, the letter contains several grave misinterpretations of our intentions (eg, "prior bias") and of our results that require a response.
Regarding the AAOO criteria (Table 2), we consider control of vertigo the major factor in evaluating the success or failure of treatment, and, therefore, we regard classes A, B, and C as success and only class D as failure. Also Brackmann and Anderson (ORL 1980;42:101-118) used control of vertigo as success rate. When doing so, there is no significant difference between the effect of the active (shunt) operation and the placebo (mastoidectomy) operation.
Concerning Dr Arenberg's remarks about our statistical methods (eg, "seem to be highly scientific," "poor in design," "errors of interpretation or bias," "analytical method standard use in the United States"), they speak for themselves. Not only