Challenges in reducing the burden of otitis media disease: an ENT perspective on improving management and prospects for prevention.

Acute otitis media (AOM) is a major public health concern. This frequent disease of childhood is a leading cause of physician visits, a major component of paediatric healthcare burden, and a key contributor to antibiotic resistance. An international expert group comprising mainly ear, nose, and throat physicians met in June 2008 to discuss the optimal management of AOM, particularly with regards to unmet needs in diagnosis and management. Current guidelines do not help identify which patients are most at risk for severe or complicated AOM. Diagnosis of AOM is also complicated by a lack of correlation between clinical signs and symptoms and responsible pathogens. Consequently, treatment of AOM is not always appropriate, and the long-term overuse of antibiotics in AOM reduces the effectiveness of treatment and places children at risk for drug-resistant infections. There is a need for educational and research initiatives to improve diagnostic accuracy and management of AOM. Because there is currently no ideal treatment, vaccination is an attractive additional approach for managing AOM and reducing its burden.