Review

• the responsibility of review of acute otitis media can be left with the patient or the child's parents in the majority of cases: explain the natural course of the illness, but particulary that the patient is likely to suffer occasional niggling pains in the ear and will be slightly deaf for some six weeks. If the illness does not follow the natural course or if there is any doubt about the patient's hearing at six weeks, the patient should be reviewed.
• if the ear has discharged, explain that the severe pain usually settles quickly and the discharge should stop over three to four days. This patient is normally reviewed after a week, as when the drum has discharged it is impossible to view the drum clearly to exclude other diagnoses. Review the patient early if the severe pain persists or the discharge is a problem.
• children older than two years who have otitis media with effusion and normal developmental must be seen at three- to six-month intervals (1)
  • they should be obsereved until,
    • effusion is resolved
    • hearing loss is identified
    • structural abnormalities of the tympanic membrane or middle ear are suspected
  • hearing and language testing is recommended in the following situations
    • in patients with suspected hearing loss or persistent effusion for at least three months
    • when developmental problems are identified.
• the patient should also be reviewed if there are features to suggest the patient may have had a recent serous otitis media/glue ear or if there is a history of recurrent otitis media.

Reference:

• (1) Kalyanakrishnan R et al. Diagnosis and treatment of otitis media.Am Fam Physician  2007; 76:1650-8, 1659-60