There is recent evidence that approximately half of patients with acute otitis media may have a concurrent viral infection in the middle ear. This may explain why some cases of otitis media do not respond to antibiotics. Penicillin-resistant pneumococcus represents one of the biggest health care challenges. Up to 30-40 percent of isolates are amoxicillin resistant. If effusion persists after this period, refer to an ENT specialist.
Further treatment is futile and expensive.
In some studies, oral steroids have shown to be beneficial, but are of limited long-term value. One caveat to this is those patients with documented seasonal or perennial allergic rhinitis. Nasal steroids have also been recently advocated for OME, but its role has yet to be defined. OME present for longer than 3-4 months should also be referred. If speech delay is present, initiate a speech consult.