FIGURE 58.2 A: Normal tympanic membrane (TM) B: TM full/mild bulging (antibiotic treatment not indicated) C: TM with moderate bulging D: TM with severe bulging Antibiotic treatment of AOM has been controversial due to the high spontaneous resolution rate of AOM in many older studies Using a more stringent diagnostic threshold for AOM, recent studies have documented a modest but statistically significant benefit of antibiotics for AOM Antibiotic treatment is recommended for any child with AOM and severe symptoms, defined as moderate or severe otalgia, otalgia for greater than 48 hours or temperature >39°C (102.2°F) For children between and 24 months of age, observation without antibiotics is an option if AOM is unilateral and symptoms are not severe Observation is an option for patients >24 months of age with AOM without severe symptoms even if the AOM is bilateral In all cases for which observation is the chosen option, the clinician must arrange for follow-up