Like Chris Cates, I don't routinely use antibiotics to treat otitis media. It's very clear that antibiotic use .. especially macrolides.. will lead to antimicrobial resistance. When I do use antiobotics, I always use 1st-line agents. Making the decision to use antiobotics remains a challenging one. Gotta make the right doagnosis to start.
A recent addition to our practice is an acoustic reflectomoeter. The only brand that I've been able to find is the Ear-Check Pro. The device is simply wonderful! There are a few papers from the mid-1990's on this topic. The compelling feature is that the decise permits us to confirm normal ears quite well: "[ears]were found to be highly predictive for normal ears as much as tympanometry." {ref} So we can distinguish the red normal ear from the infected red ear without the struggles required for insufflation & observation of mobility. The Acoustic reflectometer does not require that a seal be established, and takes only 1-2 seconds to provide a good reading. No .. I don't own stock in the company ... and I doubt they're doing very well. We bought ours last summer, and the AA batteries in the package had expired in 1998!