Otitis media is the most common disease of children who seek medical care. It is estimated that over 30 million visits to physicians are made per year, and that over one billion dollars are spent annually in the United States for the treatment of otitis media. More prescriptions are written for oral antimicrobial agents for otitis media than any other disease. Antimicrobial therapy is still the mainstay of treatment for children with acute otitis media. Myringotomy (and tympanocentesis) should also be performed when acute otitis media is associated with: severe otalgia, when otalgia or fever persists or recurs in spite of antimicrobial therapy, in the very young or immunocompromised host and when a suppurative intratemporal or intracranial complication is impending or present. Antimicrobial agents should be selected according to the incidence of bacteria prevalent in the community and should be altered depending upon the results of cultures obtained from middle ear aspirates in children who are not responding to the usual antimicrobial agents. Children who experience frequently recurrent acute otitis media (without a middle ear effusion between attacks) should be considered candidates for prophylactic antimicrobial therapy or tympanostomy tube insertion, or both. A middle ear effusion that has persisted for three months or longer should be considered chronic and active treatment should be instituted. A course of antimicrobial therapy should be tried, and if not effective, then a myringotomy with aspiration of the effusion is indicated.(ABSTRACT TRUNCATED AT 250 WORDS)