Introduction To keep up with an increasing knowledge of the natural course and pathogenesis of AOM and an increasing antimicrobial resistance problems the SwedishHealth Authorities have initiated consensus conferences with production of guidelines on this subject in 1991, 2000 and 2010. The guidelines have focussed on diagnostics, etiology, antibiotic treatment, complications and follow up. Objective The objective is to present the hallmarks of the 2010 Swedish guideline or recommendations for diagnostics, treatment and follow up of AOM. The experts involved in the development of the guidelines represented otorhinolaryngology, family medicin, bacteriology and pediatrics. Furthermore the presentation will also make a brief description of the Swedish recommendations for tympanostomy tube treatment in children with OM introduced in 2010. Results In brief the guidelines put pressure on an adequate diagnosis and an active expectans or appropriate antibiotic treatment. In children between one year of age up to twelve with AOM active expectans is recommended and children should only be treated with antibiotics if complicating factors occur. The treatment drug of choice is penicillin V. A follow up procedure at 3 months should be considered but is not mandatory eg in unilateral AOM in a child with a known normal hearing. Regarding tympanostomy treatment the recommendations focus on more than 3 episodes of AOM in 6 month and for OME the major indication is the degree of hearing. Discussion Twentyfive years with national guidelines, including strengthened aspects of diagnostics anda restrict antibiotic policy, are now quite well adopted by the Swedish physicians. Despite the altered antibiotic policy any increasing rates of complications have not been observed. However, still there appears to be an over-consumption and use of broad-spectrum antibiotics. Regarding tympanostomy tube treatment the frequency appears to be limited in comparison to the situation in some of our neighbour countries e.g. Denmark.