To the Editor .— In addition to an appropriate history, the recommended definition of acute otitis media (AOM) in “Diagnosis and Management of Acute Otitis Media”1 requires the presence of middle ear effusion (MEE) and signs or symptoms of middle ear inflammation. Unfortunately, although several otoscopic findings are given in Table 2 to satisfy the criterion of presence of MEE, the only specified otoscopic finding of middle ear inflammation is “distinct erythema of the tympanic membrane.” Although bulging of the tympanic membrane (TM) is appropriately included as a means of …
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Hoover et al. (2005) studied this question.