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Watertown, Mass

To the Editor: The original contribution by Brian F. Degenhardt, DO, and Michael L. Kuchera, DO,¹ in the June 2006 issue of JAOA—The Journal of the American Osteopathic Association was an interesting article evaluating the efficacy of osteopathic manipulative treatment (OMT) for patients with otitis media. Drs Degenhardt and Kuchera¹ conclude, "Osteopathic evaluation and treatment was shown to be beneficial in treating 5 (63%) of 8 subjects in this cohort with documented recurrent otitis media."

It should be emphasized that the absence of a control group in this prospective experiment prohibits one from drawing any firm conclusions. Therefore, it is impossible to determine if OMT actually reduced the incidence of otitis media in this study.

In addition—given the high prevalence of allergic rhinitis and its association to otitis media^2-4—any study carefully evaluating the effects of OMT on patients would need to control for other types of therapies for allergic rhinitis, such as antihistamines, intranasal corticosteroids, and mast cell stabilizers. The study by Drs Degenhardt and Kuchera¹ lacks such controls.

I applaud the authors' efforts to study the efficacy of OMT. However, I hope they will be able to enroll larger numbers of patients in their next study.

References
1. Degenhardt BF, Kuchera ML. Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study. J Am Osteopathic Assoc. 2006;106:327-334. Available at: http://www.jaoa.org/cgi/content/full/106/6/327. Accessed July 27, 2007.

2. Nathan RA. The burden of allergic rhinitis [review]. Allergy Asthma Proc.2007; 28:3 -9.[Medline]

3. Chantzi FM, Kafetzis DA, Bairamis T, Avramidou C, Paleologou N, Grimani I, et al. IgE sensitization, respiratory allergy symptoms, and heritability independently increase the risk of otitis media with effusion. Allergy. 2006;61:332 -336.[Medline]

4. Fireman P. Otitis media and eustachian tube dysfunction: connection to allergic rhinitis [review]. J Allergy Clin Immunol.1997; 99(2):S787 -S797.[Medline]

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