Comparison of clinical practice guidelines for the diagnosis and management of AOM in children in Japan in 2006, with revisions published in 2009 [11] and 2013 [12].

The main difference between the first and second guidelines is the recommendation for duration of antimicrobial use. All guidelines recommend myringotomy for all AOM with severe otoscopic findings. The first and second guidelines recommend second myringotomy for all treatment-resistant AOM, and the third recommends myringotomy on a case-by case basis. Indications for myringotomy are the same in the first and second editions.Comparison of clinical practice guidelines for the diagnosis and management of AOM in children in Japan in 2006, with revisions published in 2009 [11] and 2013 [12].