An approach to difficult management problems in otitis media in children.

BACKGROUND Otitis media is one of the most common pediatric diseases encountered by family physicians. While isolated, acute episodes pose little clinical difficulty, recurrent infections and persistent middle ear effusions can be perplexing problems. METHODS This review presents a clinical approach to the management of recurrent and persistent middle ear disease. RESULTS AND CONCLUSIONS Recurrent infections can be treated with a trial of daily prophylactic antibiotics to decrease the rate of recurrence. Should infections continue to recur despite the daily prophylaxis, polyethylene tube placement is warranted to drain surgically the middle ear effusions that give rise to the recurrent infections. Acute episodes of otitis media are commonly followed by prolonged, asymptomatic periods of middle ear effusion. Patients with this disease have decreased hearing leading to potential deficits in their speech and academic development. If such effusions do not spontaneously resolve within 2 months, repeated courses of antibiotics with the possible addition of a course of oral steroids are warranted to speed resolution of the effusion before proceeding to placement of polyethylene tubes.