Recent advances in the pathogenesis, diagnosis, and management of otitis media.

1. Otitis media is one of the most common diseases of childhood. 2. Pathogenesis is related to eustachian tube dysfunction. 3. Etiology is primarily bacterial (S. pneumoniae, 40 per cent; H. influenzae, 20 per cent). Bacteria are also present in chronic otitis media with effusion ("secretory otitis"). 4. H. Influenzae is present in all age groups, and 15 to 30 per cent are ampicillin-resistant. 5. Diagnosis is by pneumatic otoscopy, or tympanometry, or both. 6. Tympanocentesis and/or myringotomy is important diagnostic-therapeutic procedure in selected patients. 7. Ampicillin (or amoxicillin) is initial therapy of choice. 8. Erythromycin and sulfonamide, trimethoprim-sulfamethoxazole, or cefaclor is recommended for those who have poor clinical response to initial antimicrobial therapy. 9. Efficacy is yet to be shown for antimicrobial prophylaxis, decongestants, antihistamines, myringotomy and tympanostomy tubes, and adenoidectomy with or without tonsillectomy. 10. Attendant conductive hearing loss is probably related to abnormalities in cognition, language, and learning.