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Am J Dis Child. 1968;115(3):392-393. doi:10.1001/archpedi.1968.02100010394022.
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To the Editor.—Dr. Stickler's continuing contributions (Stickler, G.B., et al, Treatment of Acute Otitis Media in Children: IV. A Fourth Clinical Trial, Amer J Dis Child114:123-130, 1967) are very valuable to practicing physicians—generalists, otolaryngologists, and pediatricians alike.

In actual practice and in the clinical instruction of medical students and house officers, I have found considerable confusion over the physical criteria to be used for the diagnosis of acute otitis media. Dr. Stickler in all his articles has used redness, bulging, changes in the light reflex, and perforation of the drum. While redness and changes in the light reflex certainly do occur early in otitis media, they can also be caused by crying (as Dr. Stickler mentions), fever, and the edema of the mucosa of the middle ear and eustachian tube which accompanies a viral upper respiratory tract infection, without necessarily signifying viral or bacterial invasion of the


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