I have read with great interest the recent article by Bhargava and Chakravarti which shows that mometasone nasal spray is effective for the treatment of otitis media with effusion in patients with adenoidal hypertrophy . We have previously reported our experience on the positive effect of nasal steroids on symptoms due to adenoid hypertrophy in adolescents . In this study we have shown that nasal steroids have a significant advantage over placebo on nasal symptoms other than rhinorrhea, but failed to detect any difference between nasal steroids and placebo in decreasing the size of the adenoid hypertrophy observed during nasopharyngeal endoscopic evaluation. One possible reason for this result is the fact that, similar to the authors, we have not taken into account the allergic status of our patients. Evidence have shown that otitis media is associated with allergic rhinitis . On the other hand, one recent study has suggested that allergic rhinitis is rarely present in children with adenoidal hypertrophy accompanied by otitis media with effusion . For this reason, I believe, a study which hypothesizes that nasal steroids are effective for the treatment of otitis media with effusion has better imply what percentage of patients also have a diagnosis of allergic rhinitis or has better exclude subjects with allergic rhinitis, or include a subgroup of patients with allergic rhinitis for comparison with those that are not allergic. I strongly agree with the authors that the use of nasal steroids in the management of otitis media with effusion with adenoidal hypertrophy should be advocated; however the question whether children with allergic rhinitis will more or less likely benefit from this therapy remains to be answered.

I also would like to report a couple of erratum that I noticed; in table 1; p value for the difference between two groups in terms of pure tone averages is not shown. Additionally, actual values of nasal obstruction, snoring, OSA, rhinorrhea and cough scores are not shown in the table or anywhere in the manuscript. In the references of the manuscript, references number 4 and 18 are the same, but the publishing year has been miswritten.