Otitis Media – practice changes: No Antibiotics Please

Like Chris Cates, I don't routinely use antibiotics to treat otitis media.  It's very clear that antibiotic use .. especially macrolides.. will lead to antimicrobial resistance.   When I do use antiobotics, I always use 1st-line agents.  Making the decision to use antiobotics remains a challenging one.  Gotta make the right doagnosis to start. 

A recent addition to our practice is an acoustic reflectomoeter.  The only brand that I've been able to find is the Ear-Check Pro. The device is simply wonderful!   There are a few papers from the mid-1990's on this topic.  The compelling feature is that the decise permits us to confirm normal ears quite well:  "[ears]were found to be highly predictive for normal ears as much as tympanometry." {ref}    So we can distinguish the red normal ear from the infected red ear without the struggles required for insufflation & observation of mobility.  The Acoustic reflectometer does not require that a seal be established, and takes only 1-2 seconds to provide a good reading.  No .. I don't own stock in the company … and I doubt they're doing very well.  We bought ours last summer, and the AA batteries in the package had expired in 1998!

ref: Int J Pediatr Otorhinolaryngol 1999 May 5;48(2):137-42