An evidence-based approach to treating otitis media

Patient care is ideally based on evidence derived from the best available studies. The practitioner who treats children with otitis media is fortunate in this regard, because a wealth of high quality clinical trials and epidemiologic studies have been published. Further, much of this evidence has been synthesized into bottom-line efficacy estimates and treatment guidelines that deal specifically with the medical management of otitis media.

Otitis media implies the presence of a middle ear effusion (MEE), or fluid in the middle ear space  MEE accompanied by acute symptoms is called acute otitis media (AOM). AOM is caused by ascent of viral or bacterial pathogens from the nasopharynx into the middle ear during an upper respiratory infection. MEE without associated symptoms is called otitis media with effusion (OME). OME may arise as a sequelae to AOM or spontaneously; the latter is also called silent otitis media when it occurs as an incidental finding during physical examination or screening tests. The nonspecific term ear infection applies to AOM and OME, because pathogenic bacteria generally are present in the middle ear with both conditions.

This article presents an evidence-based approach to managing otitis media. Rational management begins by understanding the natural history of untreated otitis media and knowing what to expect from medical therapy Next, a stepwise treatment plan is presented, based on epidemiologic studies, systematic reviews of clinical trials, and personal experience as a pediatric otolaryngologist who has successfully treated thousands of children with otitis media.