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To the Editor: The article entitled "Acute Otitis Media in Children" by M. M. Rubenstein et al in the April 1965 issue of the Journal was of interest, and I was pleased to note their conclusion that penicillin used with triple sulfonamides are the drugs of choice. I was disturbed by the statement, "We have concluded that myringotomy is rarely if ever indicated in the management of acute otitis media." I would agree that myringotomy is not indicated in that large group of patients who present with acute otitis media and who have not previously been on antibiotics. However, I feel that myringotomy may be indicated in that small group of patients who have been on appropriate antibiotics four or five days and who continue to have a bulging tympanic membrane. These would be the cases most likely to develop serous otitis media, which some authors feel predisposes patients to