The Medical Appropriateness of Tympanostomy Tubes Proposed for Children Younger Than 16 Years in the United States

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Abstract
IT IS A REALITY of contemporary medical practice that many therapeutic interventions have never proved their worth through rigorous scientific investigation. Even when the benefit of a treatment (such as tympanostomy tube placement) has been documented, there is often little consensus among experts as to the most appropriate patients for whom it should be employed. These varying attitudes exist, in large part, because there is a dearth of the long-term efficacy data that are needed to generate convincing arguments for or against a particular indication. In this time of constricting health care resources, much interest has become focused on "outcomes research" as a means of improving both the quality and the cost-effectiveness of medical care. Only through careful study of the results of treatment can rational guidelines for its appropriate use be developed. In their recent article on the medical appropriateness of tympanostomy tubes, Kleinman et al1 reached the

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