Abstract
<h3>To the Editor.</h3> —We are concerned about several aspects of the report by Dr Kleinman and colleagues<sup>1</sup>on use of tympanostomy tubes in children. Children with recurrent acute otitis media who fail antibiotic prophylaxis are appropriately considered for placement of ventilating tubes but were identified as "inappropriate" or "equivocal" in the report. We have identified tube insertion for this indication in our publications,<sup>2</sup>and there is additional convincing evidence to support this usage.<sup>3,4</sup>A recent clinical trial reported in 1992 by Casselbrant and coworkers<sup>5</sup>addressed this question and again supported use of tympanostomy tubes for children with recurrent acute otitis media who fail antibiotic prophylaxis. The rapid emergence of resistant bacteria such as penicillin-resistant<i>Streptococcus pneumoniae</i>during the past few years may make indications for surgical intervention an even more important alternative to antimicrobial treatment and prophylaxis. We participated in the panel convened by Value Health
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