The decision to treat is usually made after a combination of physical exam and laboratory diagnosis, with additional testing including audiometry , tympanogram , temporal bone CT and MRI .    Decongestants,  glucocorticoids,  and topical antibiotics are generally not effective as treatment for non-infectious, or serous , causes of mastoid effusion.  In less severe cases or those without significant hearing impairment, the effusion can resolve spontaneously or with more conservative measures such as autoinflation .  In more severe cases, tympanostomy tubes can be inserted, possibly with adjuvant adenoidectomy . 
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As White House Chief of Staff, Sununu reportedly took personal trips, for skiing and other purposes, and classified them as official, for purposes such as conservation or promoting the Thousand Points of Light .  The Washington Post wrote that Sununu's jets "took him to fat-cat Republican fund-raisers, ski lodges, golf resorts and even his dentist in Boston."  Sununu had paid the government only $892 for his more than $615,000 worth of military jet travel.  Sununu said that his use of the jets was necessary because he had to be near a telephone at all times for reasons of national security.  Sununu became the subject of much late-night television humor over the incident.  Sununu worsened the situation shortly afterwards when, after leaking rumors of financial difficulties in his family, he traveled to a rare stamp auction at Christie's auction house in New York City from Washington in a government limousine , spending $5,000 on rare stamps.  Sununu then sent the car and driver back to Washington unoccupied while he returned on a corporate jet.  In the course of one week, 45 newspapers ran editorials on Sununu, nearly all of them critical of his actions.  Sununu resigned his White House post on December 4, 1991.