Criteria for the diagnosis of acute otitis media - both of the following:
(1) presence of middle ear effusion
(2) rapid onset (progression over 48 hours) of clinical signs and symptoms (as described below)
Identification for a middle ear effusion may be based on:
(1) tympanocentesis
(2) fluid in the external ear canal in the presence of a ruptured tympanic membrane
(3) limited or absent mobility as demonstrated by pneumatic otoscopy, tympanogram or acoustic reflectometry.
Evidence of an effusion may or may not be accompanied by:
(1) opacification of the tympanic membrane (not including erythema)
(2) full or bulging tympanic membrane
(3) hearing loss
Rapid onset of clinical signs and symptoms may include 1 or more of the following:
(1) otalgia (or pulling on the ear by an infant)
(2) otorrhea
(3) irritability in an infant or toddler
(4) fever
Anorexia, nausea or vomiting may or may not be present.
