Introduction.

There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.

--Mark Twain, Life on the Mississippi, 1883

As a physician scientist, I have always reflected on Mr. Twain's words of wisdom. I found myself especially reminded of them as I followed the introduction of ototopical fluoroquinolones in 1998 and the controversies that followed thereafter. From scurrilous asides to stalwart objections, a flurry of scientific fodder, both pro and con, has been cast upon the otologic literature as well as the lay press.

In an effort to sort out the medical morass, the participants in the seminar that yielded this supplement used an evidence-based approach to examine four issues:

* the definitions used in clinical trials to support advances in ototopical therapies

* the ecologic impact, if any, of these therapies

* the efficacy of these therapies and the causes of treatment failures

* the safety and efficacy of adjunctive steroids added to newer formulations

It is our hope that this supplement will provide physicians with the state-of-the-art conclusions regarding these issues and, more important, that it will guide best-practice treatment choices for our patients. Furthermore, Mr. Twain, we hope to provide you with wholesale returns of fact out of trifling investments of conjecture.

Joseph E. Dohar, MD, MS, FAAP, FACS Supplement Editor