Acute suppurative otitis media in children. Diversity of clinical diagnostic criteria.

Practicing pediatricians were surveyed via mailed questionnaire and a review was made of the pertinent literature in an attempt to identify suitable criteria for making the clinical diagnosis of acute suppurative otitis media (ASOM) in children. Clinical diagnostic criteria were described in only 26 of the 43 studies reviewed; 18 different sets of criteria were used. Use of identical criteria in more than one study was usually the result of multiple publications by particular authors rather than agreement between two investigators. One hundred and sixty-five questionnaire respondents proposed 147 different sets of criteria. Only 11 criteria sets were proposed by more than one respondent, and no single set was listed by more than six respondents. Greater standardization of clinical diagnosis is desirable, but difficult to achieve and will require additional studies to correlate clinical findings with objective measures of diagnosis, such as tympanocentesis.