Otitis media reassessed. Up-to-date answers to some basic questions.

For children with acute otitis media, appropriate antibiotic therapy provides a modest improvement over the high rate of spontaneous recovery and, more importantly, has greatly reduced the incidence of serious complications. Prophylaxis with antibiotics is beneficial for patients with recurrent episodes. Otitis media with effusion also has a high rate of spontaneous resolution, and many physicians have adopted a "wait and see" approach to this problem. Modification of risk factors may be helpful. Antibiotic therapy is recommended for infants who have otitis media with effusion (since they cannot relate symptoms); patients with a coexisting purulent infection of the upper respiratory tract; patients who have significant hearing loss, vertigo, or structural changes in the tympanic membrane; and patients who have had effusion for more than 2 to 3 months. Referral to an otolaryngologist should be considered if medical therapy for recurrent acute otitis media or chronic otitis media with effusion has failed or been poorly tolerated, or if complications are present.