Table 1

 Key points of the two guidelines: diagnosis

Scottish Intercollegiate Guideline NetworkAmerican Academy of Pediatrics
Diagnostic features:Recommendation: The clinician should confirm a history
• Earache, fever, and irritabilityof acute onset, identify signs of middle ear effusion:
• Middle ear effusion• Bulging of the tympanic membrane
• Opaque drum• Limited or absent mobility of the tympanic membrane
• Bulging drum• Air-fluid level behind the tympanic membrane
• Impaired drum mobility• Otorrhea
• Hearing lossand evaluate for the presence of signs and symptoms of middle ear inflammation:
Ear related symptoms may include earache, tugging or rubbing of the ear, irritability, restless sleep and fever Otoscopic appearances include bulging tympanic membrane with loss of normal landmarks, change in colour (typically red or yellow), and poor mobility• Distinct erythema of the tympanic membrane or • Distinct otalgia (discomfort clearly referable to the ear(s) that results in interference with or precludes normal activity or sleep)