ABSTRACT
In this chapter the authors focus to thread their way through the often conflicting evidence about the practical management of acute otitis media (AOM) at the same time as covering what is known of the pathology, epidemiology and complications of this commonest of childhood illnesses. Differential diagnosis includes AOM, otitis externa, furunculosis and reactive lymphadenopathy. Myringotomy may help establish the infective agent if evidence has not been obtained from lumbar puncture. Streptococcus pneumoniae is the most common bacteria isolated from the middle ear in AOM, and it has been reported in 18–55% of cases. The Eustachian tube is traditionally assumed to be the main route by which organisms reach the middle ear, though there are relatively few studies to confirm this. A meta-analysis of risk factors has shown that the risk increased for other family members. Attempts have therefore been made to try to identify a subgroup of children who may benefit from immediate antibiotics.
