Section two: otitis media.

With the widespread use of vaccinations against Streptococcus pneumoniae, the frequency of acute otitis media (OM) has decreased significantly in recent years. Current management varies considerably in different countries, but there is consensus that most mild cases in children older than 6 months can be treated with observation and analgesics. When antibiotic therapy is indicated for children younger than 6 months or older children with severe or unrelenting symptoms, initial management with amoxicillin or amoxicillin-clavulanate is recommended. For children with recurrent OM or persistent serous OM, prophylactic antibiotic regimens appear to be effective. Insertion of tympanostomy tubes can be useful to prevent recurrences but confers little benefit on speech acquisition. Tonsillectomy and adenoidectomy yield minimal benefit for children with OM.