The wicked problem of otitis media: summary of recent systematic reviews on otitis media with effusion.

Otitis media (OM) is a wicked problem. Millennia ago, middle ear disease was described in the ancient Egyptian Ebers Papyrus and Indian Sushruta Samhit ('Compendium'). Centuries ago, Italian anatomists (Bartholomaeus Eustachius ∼ 1563; and Antonio Valsalva ∼ 1704) described the structures and technique for draining middle ear pus that still bear their names. Recently, immunological studies have broadened our understanding of the important inflammatory and immune responses in middle ear disease. Despite all of this knowledge, we have made no real progress eliminating this disease that nearly every child will still experience, although the severe life threatening forms are much less common. Colonised High Income Countries have recorded evidence of middle ear disease among the indigenous populations for centuries and the massive disparities in disease burden persist. We have made little progress, indeed may have gone backwards, managing OM with priority populations, such as First Nations children. More broadly, OM is one of the commonest reasons for children to attend healthcare, be prescribed antibiotics and undergo surgery. Therefore, it has a significant impact on health-spending and antibiotic resistance as well as morbidity for children, including hearing impairment, balance disturbance, behavioural disruption, speech and language and other delays with all the consequent life-course impacts, including justice system contact. Perhaps OM is not eradicable, but we must do better to contain the recurrent, persistent and severe forms.