Note: Funding Information: Competing interests We have read and understood the BMJ policy on declaration of interests and declare the following interests: RPV is co-investigator and collaborator in trials comparing topical with oral antibiotics for children with acute otitis media and acute ear discharge funded by the Netherlands Organisation for Health Research and Development (ZonMw) and the NIHR HTA programme and principal investigator on a grant proposal for a trial comparing anaesthetic ear drops to usual care in children with acute otitis media to ZonMw (pending funding decision). AGMS is co-investigator in trials comparing topical with oral antibiotics for children with acute otitis media and acute ear discharge funded by the Netherlands Organisation for Health Research and Development (ZonMw) and the NIHR HTA programme and on a grant proposal for a trial comparing anaesthetic ear drops with usual care in children with acute otitis media to ZonMw (pending funding decision). As director of the NIHR UCLH BRC Hearing Theme and national specialty lead of NIHR CRN ENT, AGMS advises companies on the design and delivery of clinical trials in the field of otitis media and hearing loss and serves on the Scientific Advisory Board of Novus Therapeutics. MvdH is a patient and public involvement member in a trial comparing topical with oral antibiotics for children with acute otitis media and acute ear discharge funded by the Netherlands Organisation for Health Research and Development (ZonMw) and patient and public involvement member in a grant proposal for a trial comparing anaesthetic ear drops with usual care in children with acute otitis media to ZonMw (pending funding decision). ADH is chief investigator and collaborator of trials comparing topical with oral antibiotics for children with acute otitis media and acute ear discharge funded by the NIHR HTA programme and the Netherlands Organisation for Health Research and Development (ZonMw) and collaborates on a grant proposal for a trial comparing anaesthetic ear drops with usual care in children with acute otitis media to ZonMw (pending funding decision).