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Cohort study
About half of children under age 3 whose parents suspected acute otitis media do not have the diagnosis; restless sleep, ear rubbing, crying, irritability and fever are not predictive
  1. Eugene Leibovitz
  1. Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
  1. Correspondence to Eugene Leibovitz
    Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; eugenel{at}

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The American Academy of Pediatrics clinical practice guideline for acute otitis media (AOM) was published in 2004 in order to help physicians to make an accurate acute diagnosis.1 According to these guidelines, presence of middle ear effusion and signs and symptoms of middle ear inflammation, together with a history of acute onset, are required for diagnosis and evaluation of disease severity. In clinical trials, AOM symptoms have been used for evaluation of disease severity in order to assign patients to different treatment groups (including ‘watchful waiting’) and follow-up. A clinical/otological severity score measuring patient temperature, irritability, redness of tympanic membrane and bulging was able to discern between bacterial and non-bacterial aetiology (at diagnosis) and …

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  • Competing interests None.