Sir.—The article by Dr Biedel (Journal 132:681-683, 1978) on the use of sulfonamide to modify recurrent otitis media was very interesting, especially as a study done in an active practice setting and thus presumably representative of usual practice problems. There were two areas that may merit some further discussion.
I was especially concerned with the choice of control group in this study. The use of a true placebo rather than a decongestant would have made the results more convincing. The results of the study of Olson et al1 suggest that pseudoephedrine hydrochloride may be a placebo, athough in some youngsters (especially in those with histories of allergy), this decongestant seemed to have had poorer results than did placebo in the prevention of certain middle-ear phenomena. Thus, another possible explanation for Dr Biedel's results could be that the decongestant increased the risks of recurrence rather than that the sulfonamide
PERRIN JM. Sulfonamide and Otitis Media. Am J Dis Child. 1979;133(12):1287. doi:10.1001/archpedi.1979.02130120079017
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