Abstract
<i>To the Editor</i>.—Dr David Austin<sup>1</sup>is to be commended for his courageous second look at adenotonsillectomy visa-vis chronic serous otitis media/recurrent bacterial otitis media. A number of senior otolaryngologists have, for decades, advocated an adenotonsillectomy approach to recurrent bacterial otitis media. Their work was, unfortunately, drowned out by the rush to tympanostomy tube placement. In a way, the tympanostomy tube with its complications of otorrhea, extrusion, cholesterol pearl formation, and persistent perforations represents a double-edged sword. Crying, traumatized, unhappy pediatric otologic patients have "enslaved" two generations of otolaryngologists. Adenotonsillectomy has proven to be the procedure of choice for the following conditions: upper airway compromise<sup>2-4</sup> obstructive sleep apnea<sup>2,5,6</sup> upper airway compromise with secondary cor pulmonale<sup>2,7</sup> aberrant dentofacial development<sup>8-10</sup> recurrent bacterial adenotonsillitis chronic serous otitis media/bacterial otitis media some cases of enuresis excessive daytime sleepiness<sup>3</sup> retarded intellectual and physical growth<sup>3</sup> It is indeed unfortunate that third-party health insurance carriers pay so poorly for such a wonderful procedure. When an
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