الفهرس 
Introduction Aim of the work
Aim of the workOnly 14 pages are availabe for public view
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Abstract
• Around 80% of our patients in this study had recent history of viral URTI before the development of AOM. This confirms that viral origin of the problem is most likely or at least it is a predisposing cause. Immediate use of antibiotic may provide short-term reduction in some AOM related symptoms like otalgia and fever this means one or 2 days earlier control of fever and ear pain. Few days later –by the 8th day- the effect of both symptomatic treatment alone and symptomatic treatment with use of antibiotic are very much similar. Examination 0f the TM was one of the cardinal signs to diagnose acute otitis media, to monitor the response of treatment and to observe for sequele of AOM like MEE. Our study showed us that persistent MEE after AOM is a common finding. The use of antibiotic to treat AOM did not affect such a condition. When AOM is diagnosed in otherwise normal kid, close watching with follow up for these patients should be the primary goal for the physician, Antibiotic should be reserved for those kids with some co-morbidities like immune-deficiency, malnutrition, or craniofacial abnormalities. Symptomatic treatment of AOM without using antibiotics avoids the side effects of antibiotics and minimizes the chance of development of antibiotic resistanceCeftriaxone injection for 3 days provided excellent results in controlling infection in patients with treatment failure, whether the initial treatment was symptomatic or with augmented amoxicillin. Watchful waiting does not mean to tell the patient don’t come back your problem is a self-limited problem and eventually it will improve. It absolutely means regular and close follow up until the infection subsides.