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PEDIATRICS Vol. 109 No. 4 April 2002, pp. 717-718

Definition and Diagnostic Criteria for Acute Otitis Media

To the Editor—

In their recent article on acute otitis media (AOM), Chan et al1 provide an important guide for future research. However, clarification is needed regarding their diagnostic criteria. According to the authors, a child must have <48 hours of signs and symptoms, and a middle ear effusion "with or without the following: a) opacification, not including erythema, and b) a full or bulging tympanic membrane." We feel these criteria are too loose and too stringent at the same time. Consider the following:

Scenario one: an 18-month-old with rapid onset of upper respiratory infection, irritability, and middle ear effusion confirmed by tympanometry, but without opacification or erythema of the tympanic membranes (TMs). Do I understand that this would meet the criteria for AOM? Children with middle ear effusion and URI symptoms are commonly encountered in our practice, but we require specific changes in their TMs to diagnose AOM. Erythema of the TM is a minimum requirement.

Scenario two: an 18-month-old with 3 days of irritability and bilateral immobile, bulging, erythematous TMs. Is it true that this patient would not fit the criteria for AOM because symptoms had been present >48 hours? A common presentation of AOM in our practice is that of a young . . . [Full Text of this Article]




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