title: The use of tympanocentesis in the diagnosis and management of acute otitis media.
abstract: Acute otitis media (AOM), when associated with a bulging or full tympanic membrane, has a bacterial etiology in more than 90% of cases. Not infrequently, the organisms present express resistance mechanisms to commonly prescribed antibiotic therapy. Tympanocentesis is a procedure advocated by several national guidelines for use in selected patients not clinically responding to antimicrobial treatment. In this paper we discuss the use of tympanocentesis as a tool to track pathogen shifts and to guide antibiotic selection. We detail the indications for tympanocentesis, compare guidelines endorsing the procedure, and describe how to implement a technique for use in the primary care setting. The pros and cons of using tympanocentesis in clinical trial designs are also presented.
authors.affiliation: University of Rochester Medical Center, Elmwood Pediatric Group, 601 Elmwood Avenue, Box 672, Rochester, NY 14642, USA. michael_pichichero@urmc.rochester.edu
authors.forename: Michael E
authors.initials: ME
authors.lastname: Pichichero
authors.forename: Tracy
authors.initials: T
authors.lastname: Wright