AOM is defined as either moderate or severe bulging of the tympanic membrane/new onset otorrhoea not due to otitis media OR mild bulging of the tympanic membrane AND recent onset of ear pain/ erythema of the tympanic membrane. Further AOM should not be diagnosed in the absence of middle ear effusion as demonstrated by pneumatic otoscopy or tympanometry.

Pain assessment and relief by using paracetamol or ibuprofen is crucial. Factors that determine need for antimicrobial therapy include the age of the child, whether the disease is unilateral or bilateral, and whether disease is severe (temperature 39 0C or higher OR severe otalgia OR otalgia persisting for more than 48 hours).

Antibiotic therapy is definitely indicated in any child with otorrhea or severe disease or bilateral AOM in children below the age of 24 months. All other situations (children older than 24 months with non severe AOM whether unilateral or bilateral) or children between 6-24 months with non severe unilateral AOM can be managed with watchful waiting for 48-72 hours or use of antibiotics either upfront or if there is failure to improve with conservative management.

The duration of therapy for severe disease and children less than 2 years is 10 days. Children between 2 and 5 years with mild disease can be treated for 7 days and those above 5 years with 5-7 days of therapy.