I should like to call to the attention of your readers a symptom which I have encountered in my general pediatric practice which has been of considerable diagnostic assistance.

Infants with otitis media who are too young to rub at or touch the affected ear frequently evidence pain, discomfort, and crying following belching.

It is my impression that belching can produce a modified Valsalva manuever, with increased pressure being exerted on the tympanic membrane through the eustachian tubes.

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