Adenotonsillectomy

To the Editor.—Dr David Austin¹ 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^2-4

• obstructive sleep apnea^2,5,6

• upper airway compromise with secondary cor pulmonale^2,7

• aberrant dentofacial development^8-10

• recurrent bacterial adenotonsillitis

• chronic serous otitis media/bacterial otitis media

• some cases of enuresis

• excessive daytime sleepiness³

• retarded intellectual and physical growth³

It is indeed unfortunate that third-party health insurance carriers pay so poorly for such a wonderful procedure. When an