Dear Editors:
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June 2007I would like to comment on your article Watchful Waiting May Be the Best Strategy, by Sheri Polley, in the November 2006 issue of ENToday. The author mentioned several ways of treating otitis media with effusion (OME) and the long-term, potentially bad, sequelae possible if one uses PETs and follows the cookbook method of going by the number of infections or lack of response to AB before using PETs. I agree that a cookbook method of treating suppurative otitis media (SOM) and OME is not good, because it leaves the treatment up to the subjective judgment of the individual physician, other health care providers, and the physician’s clinical judgment based on prior experience.
I do feel that there are many ENTs in our country who are too quick to use the PETs instead of trying other means. Many ENTs simply schedule the kids for tubes (without testing) if the pediatrician or family physician refers them for SOM, not responding to AB and decongestants. I am very conservative in my treatment, but feel that PETs are an integral part of the proper treatment of OME. My problem is that I feel that many ENTs and pediatricians are not doing enough evaluations preoperatively, such as doing OAE and tympanographic evaluation on those patients who have had failures in treatment with local and drug means.