The Red Ear-drum: To Treat or Not To Treat?
Acute otitis media is typified by the patient with fever, earache, and a "red" ear-drum. Suppurative otitis media, however, often presents without specific symptoms, and redness is the least reliable physical finding. Impaired tympanic membrane mobility on pneumatic otoscopy and bulging and opacification of the ear-drum are more reliable and important physical signs. Review of placebo-controlled trials reveals that antimicrobial therapy produces more rapid relief of fever and earache in patients with the most symptoms. Effects on patients with fewer symptoms are more modest. Amoxicillin remains the standard first-line treatment. Reasonable indications for alternative therapy are reviewed.
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N Engl J Med. 1987 Feb 19;316(8):432-7
2880294
Am J Dis Child. 1985 Jul;139(7):721-3
4014096
Pediatr Infect Dis. 1983 Jan-Feb;2(1):34-8
6601266
J Pediatr. 1982 Jul;101(1):132-6
6177846
J Pediatr. 1984 Oct;105(4):633-8
6384453
Pediatr Clin North Am. 1983 Apr;30(2):281-96
6190123
Pediatr Clin North Am. 1974 May;21(2):379-400
4134815
J Pediatr. 1986 Oct;109(4):590-5
3761072
Pediatr Infect Dis. 1985 Jul-Aug;4(4):358-61
3161007
Lancet. 1981 Oct 24;2(8252):883-7
6117681
Pediatrics. 1987 Apr;79(4):520-3
3822670
Ann Otol Rhinol Laryngol Suppl. 1979 Sep-Oct;88(5 Pt 2 Suppl 60):13-28
115359
Clin Pediatr (Phila). 1972 Apr;11(4):205-14
4537206
J Pediatr. 1986 Nov;109(5):891-6
3534203
Br Med J (Clin Res Ed). 1985 Apr 6;290(6474):1033-7
3921097
Am J Dis Child. 1968 May;115(5):542-51
4384577
J Pediatr. 1987 Dec;111(6 Pt 1):948-51
3681566
Acta Paediatr Scand. 1982 Sep;71(5):705-10
6891167
J Pediatr. 1984 Jun;104(6):826-31
6539373
Pediatrics. 1985 Jan;75(1):8-13
3871251