Acute Otitis Media Criteria
Applies the AAP criteria for acute otitis media and reports which management route the guideline leaves open.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Age of the child
- 14 months
- Objective evidence of fluid behind the eardrum
- Yes
- Bulging of the eardrum
- Moderate to severe
Result: criteria are met
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Criteria met
- Objective evidence of fluid behind the drum, plus moderate to severe bulging, new drainage not from an outer-ear infection, or mild bulging with recent pain or intense redness.
- No fluid
- The criteria are not met. The guideline says the diagnosis should not be made without objective evidence of fluid, and a crying child has a red drum.
- Redness alone
- Never diagnostic on its own. It is half of the third criterion, and only alongside mild bulging.
- Severe
- Moderate or severe ear pain, pain lasting 48 hours or more, or a temperature of 102.2 degrees Fahrenheit or higher. Antibiotics are recommended at any age.
- 6 to 23 months, both ears
- Antibiotics are recommended however mild the illness is. This is the one place where which ears are involved changes the answer.
- 6 to 23 months, one ear, mild
- Observation with close follow-up is an option, carrying a prescription held in reserve or a review within 48 to 72 hours.
- 24 months and over, mild
- Observation with close follow-up is an option, one ear or both.
- Under 6 months
- Outside this guideline, which covers 6 months through 12 years. The management recommendation does not apply.
What you enter
- Age of the child
- Both ears affected, which changes the answer only between 6 and 23 months
- Objective evidence of fluid behind the eardrum, without which no criterion is met
- Bulging of the eardrum
- New drainage from the ear, not from an outer-ear infection
- Ear pain that started within the last 48 hours
- Intense redness of the eardrum, which is never diagnostic on its own
- Moderate or severe ear pain
The other 2 fields
- Ear pain lasting 48 hours or more
- Highest temperature, severe at 102.2 or above
How this is calculated
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.