Acute Otitis Media: Bunnies, Disposables, and Bacterial Original Sin!

To the Editor .— I was truly pleased to see that Steinbach and Sectish1 tackled the important issue of pediatric resident training for acute otitis media (AOM). After all, AOM is both the most common bacterial infection diagnosed and the most frequent reason for antibiotic prescriptions in pediatrics, as the authors have clearly elucidated. Most episodes of AOM occur between 4 and 36 months of age. As such, in this often difficult to examine population, it is imperative that pediatric acolytes be exceptionally well-trained to differentiate the antibiotic-treatable (infected) tympanic membrane (TM) from the nonantibiotic-treatable (normal or otitis media with effusion) TM. Therein lies the elementary rub. Many medical schools and residency programs rarely discuss the most rudimentary aspect of properly diagnosing AOM—the equipment. Although most training programs and practicing pediatricians use the square-head Welch-Allyn otoscope, few, unfortunately, are aware of the multiple perils that can be encountered with the use of even this basic instrument for the diagnosis of AOM. These pitfalls can exacerbate the already problematic over- and underdiagnosis of AOM. Only nickel-cadmium or lithium battery-powered otoscopes …