堏titis media (OM) typically presents as either an acute infection (AOM) with symptoms including fever, otalgia, otorrhea or irritability and short duration or as otitis media with effusion (OME) which is often asymptomatic and characterised by accumulation of fluid in the middle ear. 堄iagnostic certainty of OM is challenging, given the young age of patients and symptom variability. 堏M predominantly occurs as coincident to viral upper respiratory tract infections and/or bacterial infections. 堃ommon viruses that cause upper respiratory tract infection are frequently associated with AOM and new onset OME. These include respiratory syncitial virus, rhinovirus, adenovirus, parainfluenza and coronavirus. 堐redominant bacteria that cause OM are non-typeable Haemophilus influenza, Streptococcus pneumoniae and Moraxella catarrhalis. 堁ntibiotics often do not significantly benefit most patients for AOM but long term prophylactic antibiotics can reduce the risk of OM recurrence for children at high risk. 堉n Australia, 84% of AOM is treated using antibiotics, which contributes to development of antibiotic resistance. 堖accine development is a key future direction for reducing world burden of disease but requires polymicrobial formulation and ongoing monitoring and modification to ensure sustained reduction in disease burden.