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November 1991

Corticosteroid Treatment of Otitis Media With Effusion

Arch Otolaryngol Head Neck Surg. 1991;117(11):1308. doi:10.1001/archotol.1991.01870230124023

To the Editor.—Podoshin and colleagues1 are to be commended for persisting in their study of the use of oral prednisone in the treatment of otitis media with effusion and following up their previous work with a randomized clinical trial. Before the results of this study can be applied to the care of patients, however, several problems in experimental design need to be addressed. First, none of the children in the study had received medical therapy for otitis media with effusion. This is at variance with accepted medical practice in the United States.2 Second, the children were not stratified according to known risk factors, which might have led to unequal assignment of children to treatment groups with differing potential for spontaneous remission. Third, they excluded children with an adenoid/nasopharyngeal ratio of more than 0.73, which they interpret as being pathologic. Fourth, their otoscopic severity scale (which is missing