[Consensus in the therapy of acute otitis media]

Treatment strategies in acute otitis media show important differences. To find agreement on the different therapeutic options a Dutch Consensus Conference was organized. An attitude of watchful waiting is the approach of choice for all children older than one year. Although myringotomy was advised for pain relief for many years, analgesics are the preferred symptomatic treatment at this moment. Antibiotics are useful in very young children up to age of one year, recurrences of otitis media in young children and in children in whom the infection recurs an irregular course. Myringotomy is limited to cases in which antibiotics fail to improve the middle ear condition, determination of the causative agent is mandatory or to confirm the middle ear infection if this cannot be done by mirror examination. Since the clinical course of acute otitis media has become milder in the last three decades adjustment of the present consensus will be necessary in the near future.