Management Problems in Otitis Media To the Editor: Dr. Legler's article on "Otitis Media"

key point- tobacco smoke in the child's environment. Smoke-filled rooms are considered "normal " in North Carolina. Tubes are scheduled before anyat-tempt to isolate the kids from the cigarettes. Perhaps this is intended under "compliance " prob-lems, but in our part of the world, middle ear disease and smoke have not been discussed adequately. Charlotte C. Levine, M.D. Snead's Ferry, NC The above letter was referred to the author of the article in question, who offers the following reply: To the Editor: I thank Dr. Levine for her pertinent addition to the ideas contained in my recent article on otitis media in children. Parental smoking has indeed been shown to exert a detrimental effect at all levels of a child's respiratory system. Bronchitis, pneumonia, bronchiolitis, and asthma have all been found to be worsened by par-ental smoking. l,2 Otitis media with effusion (OME) is more common in children whose parents smoke. 3,4 Of particular concern, children with OME are more likely to require surgical therapy for this disease if their parents smoke.5 Accordingly, counseling the parents to avoid smoking during the time that their child is being observed for spontaneous resolution of an episode of OME is warranted in an effort to de-crease the chance of requiring later surgical manage-ment of the OME