Intended for healthcare professionals

Clinical Review Clinical evidence

Acute otitis media

BMJ 1999; 319 doi: (Published 25 September 1999) Cite this as: BMJ 1999;319:833
  1. Paddy O'Neill, general practitioner (
  1. Norton Medical Centre, Stockton on Tees TS20 1AN

    This review of the effects of treatment for otitis media and of the effects of preventive interventions is one of over 60 chapters included in the first issue of Clinical Evidence, which is published by the BMJ Publishing Group. Future issues of Clinical Evidence will cover myringotomy; a separate chapter in issue 1 contains information on otitis media with effusion.

    Key messages

    • We found limited evidence from one RCT that non-steroidal anti-inflammatory drugs are more effective than placebo in relieving pain in children with acute otitis media

    • Evidence on the effectiveness of antibiotics is conflicting; we found no clear evidence favouring a particular antibiotic for acute otitis media

    • One systematic review of RCTs has found greater immediate benefit but no difference in long term outcome with short (≥5 days) rather than longer courses of antibiotics

    • One systematic review of RCTs has found that long term antibiotic prophylaxis has a modest effect in preventing recurrences of acute otitis media, but the questions of which antibiotic to use, for how long, and how many episodes of acute otitis media justify treatment have not yet been adequately evaluated


    Definition: Otitis media is inflammation in the middle ear. Subcategories include acute otitis media, otitis media with effusion (also known as “glue ear”), recurrent acute otitis media, and chronic suppurative otitis media. Acute otitis media presents with systemic and local signs and has a rapid onset. The persistence of an effusion beyond three months without signs of infection defines otitis media with effusion, whereas chronic suppurative otitis media is characterised by continuing inflammation in the middle ear giving rise to otorrhoea and a perforated tympanic membrane.

    Incidence/prevalence: Acute otitis media is a common condition with a high morbidity and low mortality. In the United Kingdom about 30% of children aged under 3 years visit their general …

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