Otitis media: To treat or not to treat?

Acute otitis media affects at least 80% of children younger than two years of age and is responsible for a third of physician visits of children younger than five years of age. Diagnosis must be based on more than an injected tympanic membrane; systemic signs and symptoms such as fever, irritability and reduced appetite are important, as is reduced mobility of the ear drum assessed with pneumatic otoscopy or impedance tympanometry. Once otitis media has been accurately diagnosed, treatment with antibiotics appears to improve outcomes and to reduce complications, such as mastoiditis, although results from different studies conflict.