Watchful Waiting and OME

Dear Editors:

I 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.

I decline to do urgent surgery on about 20% of patients who are referred to me, because the workup does not show significant loss of hearing or significant effusion. I do treat and follow them for several weeks to months; then, if the tests show a resistant OME, we consider PET. Many of these kids are simply teething and get referred pain to the ears, and some of them irritate their ears by either them or their parents using cotton swabs in the ears.

I also feel that the patients who reach the point of having PETs placed in the ears deserve to have proper follow-up. There are too many ENTs who just place the tubes in the TMs, tell the patient that they will fall out in six months, then discharge the patient to be followed by the pediatrician, many of whom don’t have the proper equipment to do the proper testing on follow-up. I’ve placed thousands of tubes in kids’ ears in my 25 years of practice in ENT and always follow them for about two years postop. I want to make sure the fluid doesn’t recur and the hearing is essentially normal before the children start their school years.