Acute otitis media is a bacterial infection of the temporal bone’s mucosally lined air storage spaces typically caused by Streptococcus pneumoniae, Haemophilus influenzae, or Streptococcus pyogenes. The disease is often accompanied by mastoid tenderness caused by the presence of pus in the mastoid air cells. Here, material forms within the middle ear cleft and the pneumatized mastoid air cells and petrous apex. This disease is usually precipitated by a viral upper respiratory tract infection that obstructs the eustachian tube and results in the accumulation of infected fluid and mucous. Key symptoms include fever, decreased hearing, aural pressure, and otalgia accompanied by a physical finding of erythema and decreased tympanic membrane mobility. With appropriate counseling, spontaneous healing of the tympanic membrane occurs in most cases. If, however, the perforation continues for a prolonged period of time, the patient may develop chronic otitis media. Swelling over the mastoid bone or the association of cranial neuropathies or central findings indicates severe illness requiring urgent care. Acute otitis media can often be treated successfully with a combination of antibiotics and nasal decongestants. The antibiotics of choice are frequently amoxicillin (80-90 mg/kg/day divided twice daily), erythromycin with sulfonamide (50 mg/kg/day and 150 mg/kg/day respectively), cefaclor (20-40 mg/kg/day), and amoxicillin-clavulanate (20-40 mg/kg/day). The practitioner should only resort to surgical drainage of the middle ear when the patient suffers from severe otalgia or otitis complications. Reoccurring acute otitis media can be managed with long-term antibiotic prophylaxis (typically single daily doses of sulfamethoxazole (500 mg) or amoxicillin (250 or 500 mg) over 1 to 3 months). On the other hand, if the otitis media is recurring but the patient is immunocompromised, tympanocentesis can be resorted to.