A diagnosis of acute otitis media requires: (1) a history of acute onset of signs and symptoms, (2) the presence of middle-ear effusion, and (3) signs and symptoms of middle-ear inflammation.
Elements of the definition of acute otitis media are:
1. Recent, usually abrupt, onset of signs and symptoms of middle-ear inflammation and middle-ear effusion
and
2. The presence of middle-ear effusion that is indicated by any of the following:

  1. Bulging of the tympanic membraneb.

  2. Limited or absent mobility of the tympanic membranec.

  3. Air fluid level behind the tympanic membraned.

  4. Otorrhea

and
3. Signs or symptoms of middle-ear inflammation as indicated by either:
a. Distinct erythema of the tympanic membrane
or
b. Distinct otalgia (discomfort clearly referable to the ear[s] that results in interference with or precludes normal activity or sleep)