Acute otitis media is the most common ENT pathology, childhood acute otitis media is evolving in a particular way. The place of antibiotic therapy in the treatment of this pathology is sometimes subject of controversies as evidenced by studies depending on the country. Aim: To access a therapeutic strategy for acute otitis media of the child in its congestive namely phase: is it justified the antibiotic and the place of the analgesic for this stage of otitis media? Methods: 109 patients aged 10 days to 15 years with acute otitis media in its phase congestive, attending Unit of the ENT Diseases, between 2013 and 2014 were selected for studies. Patients were reviewed at the 4th and 8th days to appreciate the aspect of the tympanic membrane (color, reliefs, hypervascularisation) and clinical signs (otalgia, fever). A therapeutic approach to antibiotic therapy and the prescription of the analgesic in the congestive phase of acute otitis media has been evaluated. Results: We noted a male predominance. The age of the patients ranged from 10 days to 15 years with an average age of 2.74 years. Our study confirms the non-systematic use of the antibiotic and the imminent place of the analgesic in the treatment of congestive acute otitis of the child. Conclusion: Congestive OMA is a frequent in children of less than three years in our unit. Our study confirms another therapeutic approach at the congestive acute otitis media of the child.