This article reviews recent publications related to the epidemiology, pathogenesis, diagnosis, and management of otitis media. Otitis media is a continuum of conditions that includes acute otitis media, otitis media with residual or persistent effusion, unresponsive otitis media, recurrent otitis media, otitis media with complications, and chronic suppurative otitis media. The pathogenic mechanisms of otitis media involve interactions among host characteristics, virulence factors of viral and bacterial pathogens, and environmental factors. Recent studies document the emergence and rapid spread of drug-resistant Streptococcus pneumoniae in acute and unresponsive otitis as well as persistent effusions and chronic suppurative otitis. Few issues in clinical medicine are as controversial as the efficacy and risks associated with antibiotic treatment of otitis media. It is best to avoid the antibiotic treatment dilemma as much as possible by not overdiagnosing otitis media.