Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner.

.On the basis of research evidence, a recommended strategy for improving the care of middle ear infections is to identify the subset of patients least likely to benefit from antibiotic therapy. They include children ages 6 months to 23 months with unilateral disease without severe signs and symptoms (moderate or severe otalgia, otalgia lasting more than 48 hours,or temperature of 39°C [102.2°F]), and those older than 2 years ofage with unilateral or bilateral disease who have mild signs andsymptoms.(9) On the basis of research evidence, the initial treatment of otitis media with effusion is watchful observation. There is little harm in observing a child who is not at risk for speech, language, or learning difficulties compared to medical or surgical intervention.(4) On the basis of research evidence, administration of the annual influenza vaccine and the conjugated pneumococcal vaccination has been shown to have a small but statistically significant impact on the frequency of middle ear disease. (7)(8) On the basis of expert opinion, optimal outcomes depend oncommunication between clinicians and parents. At a minimum , primary care clinicians should state their reasons for their own clinical judgment about appropriate management and for referral to otolaryngology if necessary.