Tympanocentesis (needle aspiration through the TM) and myringotomy (incision in the TM to provide fl uid) are the only methods directly demonstrating the presence or absence of middle ear effusion (Rosenfeld 1999). These methods also have an immediate and posi- tive effect on conductive hearing loss, which in AOM may be as signifi cant as 50 dB (Mar- golis and Hunter 1991; Hunter et al. 1994). Their role as diagnostic methods and treatment modalities has changed completely during recent decades. In 1991, Finnish medical students and GPs were advised to perform myringotomy on every patient with AOM (Palva 1991) and.
