References to the treatment of otitis media date back to Hippocrates. Myringotomy as a treatment was in vogue in the eighteenth and nineteenth centuries before its resurgence in the present day.11 The primary concern during the preantibiotic era was the potential for intracranial complications of acute otitis media.12 Historically, this was a significant cause of mortality; 70 years later, mortality from ear disease is so rare as to be occa-sionally—and regrettably—forgotten in the multitude of treatment paradigms available.

The current emphasis is more on otitis media with effusion (of the persistent or chronic variety) and on its long-term conse quences. There is a general common sense consensus that long-term untreated otitis media with effusion is an undesirable state, but it has been remarkably hard for this to be proved conclusively. There is indirect evidence to back this view,13-16 as well as the usual contrary opinion.17 This is not an area suited to randomized double-blind controlled study, as nontreatment or placebo control cannot be justified in the management of long standing OME.

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