Acute otitis media: diagnosis and drug therapy.

Diagnostic criteria for acute otitis media have become more precise with recent improvements in the otoscope and emphasis on meticulous aural toilet and careful observation of the ossicular landmarks, contour and mobility of the tympanic membrane. The treatment of the acute phase of the disease poses few therapeutic difficulties. There are many alternative antibacterial agents which have proven effective against the common middle ear pathogens. However, each drug or combination has indications and associated problems. Middle ear effusion is the most frequent sequelae of acute otitis media occurring after approximately 50% of cases in younger children. Between 5 to 10% of these effusions persist in excess of 3 months. There is intense interest in the prevention of recurrent acute otitis media (in otitis-prone children) by chemoprophylaxis, immunisation or assuring continuous middle ear ventilation by tympanostomy tube insertion. Several major projects are underway to evaluate the role of decongestants in acute middle ear disease.