Otitis media

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Observation is an option in acute otitis media in children older than six months of age with unilateral and those two years of age and older with bilateral otitis media.

Otitis media including tympanocentesis confirmed bacterial otitis media may resolve without therapy. In certain clinical scenarios 48-72 hours of observation may be indicated when followup can be assured.

This includes:

  • Children older than two
  • Children six months to two years with unilateral otitis

They must not have

  • Fever ≥39°
  • Toxic appearance
  • Otalgia lasting more than 48 hours.


Lieberthal AS, Carroll AE, Chonmaitree T, Ganiats TG, Hoberman A, Jackson MA, Joffe MD, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel DE. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-99. PMID: 23439909