OTITIS-MEDIA REASSESSED - UP-TO-DATE ANSWERS TO SOME BASIC QUESTIONS

For children with acute otitis media, appropriate antibiotic therapy p rovides a modest improvement over the high rate of spontaneous recover y 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 r ate of spontaneous resolution, and many physicians have adopted a ''wa it and see'' approach to this problem. Modification of risk factors ma y be helpful. Antibiotic therapy is recommended for infants who have o titis media with effusion (since they cannot relate symptoms); patient s with a coexisting purulent infection of the upper respiratory tract; patients who have significant hearing loss, vertigo, or structural ch anges in the tympanic membrane; and patients who have had effusion for more than 2 to 3 months. Referral to an otolaryngologist should be co nsidered if medical therapy for recurrent acute otitis media or chroni c otitis media with effusion has failed or been poorly tolerated, or i f complications are present.