Acute Otitis Media

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/

Thank you to the following content experts and Knowledge Synthesis team who led the development of this evidence repository.

Nicole Le Saux, MD

Division of Infectious Diseases, Children’s Hospital of Eastern Ontario (CHEO); Clinical Investigator, CHEO Research Institute; Associate Professor, Department of Pediatrics, University of Ottawa

Liza Bialy

Knowledge Synthesis Project Coordinator, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

Mateja Carevic, BA, MA

TREKK Knowledge Broker University of Manitoba

TREKK developed resources for healthcare providers and parents & families can be found here.

1. National Institute for Health and Care Excellence. Otitis media (acute): Antimicrobial prescribing. Public Health England. 2022.
2. The Royal Children’s Hospital Melborne. Acute otitis media. The Royal Children’s Hospital Melborne. 2021.
3. Truffert E, Fournier Charrière E, Treluyer JM, et al. Guidelines of the French society of otorhinolaryngology (SFORL): Nonsteroidal anti-inflammatory drugs (NSAIDs) and pediatric ENT infections. Short version. Eur Ann Otorhinolaryngol Head Neck Dis. 2019;136(4):289-94.
4. Intermountain Healthcare. Diagnosis and management of pediatric acute otitis media (ear infection). Intermountain Healthcare. 2019.
5. Children’s Health Queensland Hospital and Health Service. Acute otitis media – Emergency management in children. Children’s Health Queensland Hospital and Health Service. 2018.
6. Blanc F, Ayache D, Calmels MN, et al. Management of otitis media with effusion in children. Société française d’ORL et de chirurgie cervico-faciale clinical practice guidelines. European Annals of Otorhinolaryngology, Head and Neck Diseases. 2018;135(4):269-73.
7. Le Saux N, Robinson JL. Management of acute otitis media in children six months of age and older. Paediatr Child Health. 2016;21(1):39-50.
8. Heidemann CH, Lous J, Berg J, et al. Danish guidelines on management of otitis media in preschool children. Int J Pediatr Otorhinolaryngol. 2016;87:154-63.
9. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99.

1. Venekamp RP, Prasad V, Hay AD. Are topical antibiotics an alternative to oral antibiotics for children with acute otitis media and ear discharge? Bmj. 2016;352:i308.

1. Suzuki HG, Dewez JE, Nijman RG, et al. Clinical practice guidelines for acute otitis media in children: A systematic review and appraisal of European national guidelines. BMJ Open. 2020;10(5):e035343.
2. de Sévaux JL, Venekamp RP, Lutje V, et al. Pneumococcal conjugate vaccines for preventing acute otitis media in children. Cochrane Database Syst Rev. 2020;11(11):Cd001480.
3. Scott AM, Clark J, Julien B, et al. Probiotics for preventing acute otitis media in children. Cochrane Database of Systematic Reviews. 2019(6).
4. Mather MW, Drinnan M, Perry JD, et al. A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. Int J Pediatr Otorhinolaryngol. 2019;123:102-9.
5. Ranakusuma RW, Pitoyo Y, Safitri ED, et al. Systemic corticosteroids for acute otitis media in children. Cochrane Database of Systematic Reviews. 2018(3).
6. Bozzella MJ, Harik N, Newland JG, et al. From paper to practice: Strategies for improving antibiotic stewardship in the pediatric ambulatory setting. Curr Probl Pediatr Adolesc Health Care. 2018;48(11):289-305.
7. Sakulchit T, Goldman RD. Antibiotic therapy for children with acute otitis media. Can Fam Physician. 2017;63(9):685-7.
8. Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database of Systematic Reviews. 2017(10).
9. Venekamp RP, Burton MJ, van Dongen TMA, et al. Antibiotics for otitis media with effusion in children. Cochrane Database of Systematic Reviews. 2016(6).
10. Sjoukes A, Venekamp RP, van de Pol AC, et al. Paracetamol (acetaminophen) or non‐steroidal anti‐ inflammatory drugs, alone or combined, for pain relief in acute otitis media in children. Cochrane Database of Systematic Reviews. 2016(12).
11. Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015;2015(6):Cd000219.
12. Costelloe C, Metcalfe C, Lovering A, et al. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. Bmj. 2010;340:c2096.

1. McLaren SH, Cruz AT, Yen K, et al. Invasive bacterial infections in afebrile infants diagnosed with acute otitis media. Pediatrics. 2021;147(1).
2. Hay AD, Downing H, Francis NA, et al. Anaesthetic-analgesic ear drops to reduce antibiotic consumption in children with acute otitis media: The CEDAR RCT. Health Technol Assess. 2019;23(34):1-48.
3. Brinker DL, Jr., MacGeorge EL, Hackman N. Diagnostic accuracy, prescription behavior, and watchful waiting efficacy for pediatric acute otitis media. Clin Pediatr (Phila). 2019;58(1):60-5.
4. Balasundaram N, Phan D, Mazzoni D, et al. Acute otitis media in children presenting to the emergency department: Is it diagnosed and managed appropriately? J Paediatr Child Health. 2019;55(11):1335-43.
5. van Uum RT, Venekamp RP, Sjoukes A, et al. Optimising pain management in children with acute otitis media through a primary care-based multifaceted educational intervention: Study protocol for a cluster randomised controlled trial. Trials. 2018;19(1):501.
6. McCormick DP, Jennings K, Ede LC, et al. Use of symptoms and risk factors to predict acute otitis media in infants. Int J Pediatr Otorhinolaryngol. 2016;81:55-9.
7. Hoberman A, Paradise JL, Rockette HE, et al. Shortened antimicrobial treatment for acute otitis media in young children. N Engl J Med. 2016;375(25):2446-56.
8. Chonmaitree T, Alvarez-Fernandez P, Jennings K, et al. Symptomatic and asymptomatic respiratory viral infections in the first year of life: Association with acute otitis media development. Clin Infect Dis. 2015;60(1):1-9.
9. Tähtinen PA, Laine MK, Huovinen P, et al. A placebo-controlled trial of antimicrobial treatment for acute otitis media. N Engl J Med. 2011;364(2):116-26.
10. Hoberman A, Paradise JL, Rockette HE, et al. Treatment of acute otitis media in children under 2 years of age. N Engl J Med. 2011;364(2):105-15.

1. Shaikh N, Hoberman A, Kaleida PH, et al. Videos in clinical medicine. Diagnosing otitis media–otoscopy and cerumen removal. N Engl J Med. 2010;362(20):e62.