1 Departments of Pediatrics and Community Medicine, University of Pittsburgh, School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylcania 15213
In his comments concerning our article on tympanometry,1 Mortimer expresses concern that the introduction of this test into widespread clinical use would unduly escalate health care costsnot only because of the purchase and operating costs of the testing instrument, but, more importantly, because "the results of tympanometric testing would be offered as justification for expensive, traumatic, therapeutic measures (tonsillo-adenoidectomy and/or tympanos-tomy tubes) of unproven need and dubious effectiveness."2 I share some of Mortimer's concerns3any diagnostic instrument or technique is capable of being abused, or its results overinterpretedbut I disagree with the general thrust of his comments, chiefly because they present a limited view and in so doing may encourage diagnostic complacency and standpattism about a problem that I believe calls instead for increased attention to clinical observation and synthesis.