We studied 209 children, referred to a multi-disciplinary 'Glue ear/Allergy' clinic at our hospital with a history of chronic or recurrent otitis media with effusion (OME), in order to determine the prevalence of atopic disease in this population. Referrals were made either from within the hospital by Ear, Nose and Throat (ENT) Surgeons and Audiological Physicians (internal), or by General Practitioners (external). Assessment of atopic status was based on medical history, physical examination, nasal smears and skin-prick testing (SPT) in all children; and on blood eosinophil counts and total immunoglobulin E (IgE) levels in a randomly selected subset. The main outcome measures were number of children with rhinitis, asthma, eczema, positive SPT, raised IgE level (> 100 IU/l), and nasal and blood eosinophilia. We found allergic rhinitis in 89%, asthma in 36%, and eczema in 24%. SPTs were positive to one or more of eight common inhalant aeroallergens in 57% of children. Blood tests in the selected subset revealed eosinophilia in 40% and a raised serum IgE in 28%. The worldwide prevalence of allergic rhinitis in children has been estimated to be 20%. The 89% prevalence found in this study is very high and there are a number of reasons which suggest that there may be a causal relationship. Whole-population studies will be required to confirm these findings, which could have important therapeutic implications for OME.

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records, Information and Statistics Division, Common Services Agency, Edinburgh). Clearly, many factors influence reinsertion rates,2" but these factors and alternative treatments, such as hearing aids,45 need to be evaluated to avoid repeated operations in young children.I thank Mr E Alexander and Dr J Clarke for supplying information on the Scottish morbidity records. ANN EDITOR,-Ruut A De Melker failed to mention the important contribution of allergy to secretory otitis media (glue ear).' Successful treatment of glue ear by attention to underlying allergic disease has been previously reported.2' Our experience at the Royal National Throat, Nose, and Ear Hospital over the past two years in a study of over 200 children aged 3-8 years with chronic (more than six months) or recurrent (more than three episodes) glue ear is that a high proportion (over 80%) have allergic rhinitis and that treatment of this is associated with resolution of the secretory otitis media in most cases. With further respiratory tract infections there remains a tendency to impaired hearing, but this is transient.4 Evidence in support of this comes from a further study of 80 children with perennial allergic rhinitis and no hearing complaints. These underwent audiometry and tympanometry, which showed that only 17 (21%) had entirely normal hearing.The children with secretory otitis media also had a high prevalence of asthma (over 35%), often previously undiagnosed, and eczema (20%), with blood eosinophilia in 35%. Such children obviously need general assessment, not merely an examination of their ears and hearing.Allergy, although probably not the cause of glue ear, is a factor in its persistence and recurrence and should be taken into consideration when evaluating treatment methods. Medical education EDITOR,-The recent series of articles by Stella Lowry offers some profound insights into the problems, current and long standing, in medical education. We are particularly struck by the concern that doctors are now expected to work in multidisciplinary teams, not automatically as their leaders.' To respond to this development in a positive way, in Southampton we have introduced multiprofessional teaching for students from physiotherapy, occupational therapy, nursing, podiatry, and medicine. Problem based learning techniques are used, and students work in teams to define professional roles and develop management plans for patients.Feedback suggests that students enjoy the experience, acquire knowledge about professional roles and patient management, improve their teamworking skills, and develop positive attitudes towards multidisciplinary teamworking which might serve them well in their later professional practice. As facilitators, we have also learned a great deal about our professional roles.If medical education is to respond to modern developments in health care, we believe that more of this sort of teaching will be required. Cooperation between their staff and students has been extremely effective in providing a critical mass for generating...