Should Watchful Waiting Be Used More Often for Acute Otitis Media?

RECENT ANXIETY about the treatment of acute otitis media has been precipitated by a resistance to antibiotics by the common pathogens that can cause this infection.^1- 2 The medical profession is facing an increasingly impotent option in the form of antibiotics, prompting physicians around the world to consider alternatives. In this issue of the ARCHIVES, Pichichero and Poole³ have undertaken a comprehensive study involving pediatricians and otorhinologists. The objectives were to assess their recognition of the physical findings of acute otitis media and their ability to perform myringotomy. The principal issue is the safety of performing myringotomy in children with acute otitis media. Because this is an office procedure in which a general anesthetic is not administered, the child is strapped to a papoose board and held down. Myringotomy is not without potential serious complications. The superior part of the middle ear cavity contains the ossicles and the chorda tympani branch of the facial nerve. The medial wall of the cavity (which would be encountered should the physician proceed too far) contains the inner ear and is related to the internal carotid artery. Operating in such a dangerous area with a possibly mobile patient in a confined space requires practice and skill. In the study, the pediatricians and otorhinologists practiced on mannequins cleverly arranged with sacks of colored fluid to indicate if the operators had reached the right spot, gone too far, or gone too high. The competency rate was judged to be reasonable (15% made an error), although how this would translate into complications in a living, moving child is not clear.