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| ==Treatment==
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| ===Acute otitis media===
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| Treatment of acute otitis media is controversial. Much of the controversy centers around the difficulty of distinguishing viral infection from bacterial infection and the fact that viral infection can progress to bacterial infection at any time. Primary care providers, such as general practitioners and pediatricians, often have a monocular [[otoscope]] and perhaps a [[tympanometer]] as their only diagnostic tools, which makes this distinction difficult, especially if the canal is small and there is wax in the ear that obscures a clear view of the eardrum. Also, an upset child's crying can cause the eardrum to look inflamed due to causing distention of the small blood vessels on it, mimicking the redness associated with otitis media. Because of a tradition of inappropriate prescribing of antibiotics for viral acute otitis media, their use has recently been condemned by many primary care practitioners for most cases of acute otitis media. Ear specialists tend to disagree with this philosophy and promote efforts to distinguish between viral and bacterial infection, so as to optimize treatment results by giving antibiotics only for bacterial infection. Acute bacterial otitis media can cause pain that leads to sleepless nights for both children and parents, can cause eardrum perforations, not all of which heal, and can spread to cause mastoiditis and/or meningitis, brain abscess, and even death if a severe infection goes untreated long enough. High fever can occur and can cause febrile seizures. Appropriate antibiotic administration prevents most such complications. On the other hand, it is generally agreed that acute otitis media that is purely viral will usually resolve without antibiotic treatment, although associated persistent middle ear effusions may require medical intervention.<ref>{{cite journal | author = Damoiseaux R, van Balen F, Hoes A, Verheij T, de Melker R | title = Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. | journal = BMJ | volume = 320 | issue = 7231 | pages = 350-4 | year = 2000 | id = PMID 10657332}}</ref><ref>{{cite journal | author = Arroll B | title = Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews. | journal = Respir Med | volume = 99 | issue = 3 | pages = 255-61 | year = 2005 | id = PMID 15733498}}</ref><ref>{{cite journal | author = Rovers MM, Glasziou P, Appelman CL, Burke P, McCormick DP, Damoiseaux RA, Gaboury I, Little P, Hoes AW. | title = Antibiotics for acute otitis media: a meta-analysis with individual patient data. | journal = Lancet. | volume = 368 | issue = 9545 | pages = 1429-35 | year = 2006 | id = PMID 17055944}}</ref>
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| Many guidelines now suggest deferring the start of antibiotics for one to three days<!--
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| --><ref>{{cite journal | author = Damoiseaux R | title = Antibiotic treatment for acute otitis media: time to think again. | journal = CMAJ | volume = 172 | issue = 5 | pages = 657-8 | year = 2005 | id = PMID 15738492}}</ref>
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| avoiding the need for antibiotics for two out of three children<!--
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| --><ref>{{cite journal | author = Marchetti F, Ronfani L, Nibali S, Tamburlini G | title = Delayed prescription may reduce the use of antibiotics for acute otitis media: a prospective observational study in primary care. | journal = Arch Pediatr Adolesc Med | volume = 159 | issue = 7 | pages = 679-84 | year = 2005 | id = PMID 15997003}}</ref>
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| without adverse effect on longterm outcomes for those whose treatment is deferred.<!--
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| --><ref>{{cite journal | author = Little P, Moore M, Warner G, Dunleavy J, Williamson I | title = Longer term outcomes from a randomised trial of prescribing strategies in otitis media. | journal = Br J Gen Pract | volume = 56 | issue = 524 | pages = 176-82 | year = 2006 | id = PMID 16536957}}</ref> First line antibiotic treatment, if warranted, is [[amoxicillin]]. If the bacteria is resistant, then [[co-amoxiclav|amoxicillin-clavulanate]] or another penicillin derivative plus beta lactamase inhibitor is second line.
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| Prior to the invention of [[antibiotics]], severe acute otits media was mainly remedied surgically by [[Myringotomy]]. An outpatient procedure, it consists of making a small incision in the [[tympanic membrane]] to relieve pressure build-up.
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| ===Chronic cases or with effusion===
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| In chronic cases or with effusions present for months, surgery is sometimes performed by an otolaryngologist (ear, nose, and throat specialist) or by an otologist (ear specialist), to insert a [[grommet]] (called a "[[tympanostomy tube]]") into the [[eardrum]] to allow air to pass through into the [[middle ear]], and thus release any pressure buildup and help clear excess fluid within.
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| For chronic cases (glue ear), it is possible to use the [[Valsalva maneuver]] to reestablish middle ear ventilation, although repeated use of the Valsalva maneuver can cause infected matter to enter the eye cavity and cause [[conjunctivitis]].
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| ===Alternative therapies===
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| Alternatives to conventional medical approaches include [[chiropractic]] and [[Osteopathic medicine in the United States|osteopathic]] spinal manipulations, targeted to relieve muscle tension to enhance lymphatic flow and allow normal opening of the Eustachian tube. Such alternatives are becoming increasingly widely used. Otitis Media has also been found to respond to [[homeopathic]] remedies.<ref>{{cite book | title = Childhood Ear Infections: A Parent's Guide to Alternative Treatments | author = Michael A. Schmidt | publisher = North Atlantic Books | year = 2003 | isbn = 1556434421 }} [http://books.google.com/books?id=7DPwoHjD_bAC&pg=PA147&dq=osteopathy+%22otitis+media%22+chiropractic&lr=&as_brr=0&ei=7UrKR8TDLILusgO_r_XBAw&sig=rNkOdI8AQJiSex76-Kjaakj0i_8] [http://books.google.com/books?id=nGjDjqaz-fAC&pg=PA120&dq=homeopathy+%22otitis+media%22&lr=&as_brr=0&ei=7kzKR6qxEoOotgOd4aHBAw&sig=KX0P1K64Ky0mm6GvY8kBrj5joqw#PPA119,M1 ]</ref>
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| Eardoc treatment reduces the fluids in the middle ear by opening the [[Eustachian tube]]. Its efficiency can be viewed and tested with a [[tympanometer]].
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