Secretory Otitis Media: The Cantekin Affair

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To the Editor. —I appreciate the study by Cantekin et al1confirming what many of us in primary care have observed: namely, that chronic and recurrent otitis media does not respond to antibiotics. The liberal and sometimes indiscriminate use of antibiotics that are frequently prescribed by physicians can lead to, among many other problems, the often unrecognized but common condition of intestinal microbial dysbiosis and the many symptoms associated with this.2,3 This article should encourage us to be more open to understanding the cause of this condition. In 1983, Green4outlined the relationship between diet and otitis media. In 1975, Viscomi5discussed the relationship between environmental influences, particularly diet, and eustachian tube dysfunction leading to middle-ear effusions and subsequent otitis. Two important articles appeared in 1990 that emphasized this relationship between otitis media and environmental factors. Hurst6published a study of 20 patients with long-term