Acute otitis media: toward a more precise definition.

Eighty-five infants and children presenting with acute otitis media who had normal tympanic membrane landmarks and mobility within 1 month before entry into the study were studied. These criteria were used in order to avoid including children with prior otitis media with effusion (secretory otitis media). A diagnosis of suppurative otitis media was made in each case based on pneumo-otoscopic findings of diminished mobility, contour, and color of the tympanic membrane. The diagnosis was validated by myringotomy and positive culture of the middle ear fluid. A poorly mobile, bulging, yellow, opacified tympanic membrane was the most common type of tympanic membrane visualized; whereas a poorly mobile, bulging, red tympanic membrane was seen in ony 19%. The color of the tympanic membrane did not correlate with a specific pathogen isolated from the middle ear exudate. Sixty-seven per cent of children had no fever; 28% had no pain or querulous behavior.