Otitis media is one of the most common diseases in infants and children. Although long-term and life-threatening intracranial complications of this infection are now rare, cholesteatomas are still prevalent. Importantly, otitis media may lead to more subtle, and difficult to detect consequences, such as hearing loss, which may adversely impact on the child's speech development, language, cognition and behaviour. Controversies remain on the role of viral versus bacterial pathogens in the pathogenesis of otitis media and the predisposing factors in the progression from acute to recurrent or chronic infection. New antibiotics are being tested in clinical trials, but methodologic considerations may bring the validity of many of these studies into serious question. Studies are also being conducted to define the role of various modalities of medical and surgical management in chronic or recurrent otitis media. Otitis externa usually runs a more benign course. New studies have looked at the predisposing conditions, etiological factors as well as medical therapy. Necrotizing or malignant otitis media is a life-threatening infection which tends to involve older diabetic patients or others with underlying immunosuppression. Current management has moved more towards medical therapy (including hyperbaric oxygen), with surgery reserved for those not responding to antibiotics or with intracranial complications.