Otitis media is a common illness in young children. Historically it has been associated with frequent and severe complications. These days it is usually a mild condition that often resolves without treatment. This has led us to re-evaluate many interventions that were used routinely in the past. Evidence from a large number of randomised controlled trials can help in discussing treatment options with families. In Australia, Aboriginal children have more severe disease and will benefit from effective treatment of persistent (or recurrent) bacterial infection.