The use of tympanocentesis in the diagnosis and management of acute otitis media.

Acute otitis media (AOM), when associated with a bulging or full tympanic membrane, has a bacterial etiology in more than 90% of cases. Not infrequently, the organisms present express resistance mechanisms to commonly prescribed antibiotic therapy. Tympanocentesis is a procedure advocated by several national guidelines for use in selected patients not clinically responding to antimicrobial treatment. In this paper we discuss the use of tympanocentesis as a tool to track pathogen shifts and to guide antibiotic selection. We detail the indications for tympanocentesis, compare guidelines endorsing the procedure, and describe how to implement a technique for use in the primary care setting. The pros and cons of using tympanocentesis in clinical trial designs are also presented.