Acute otitis media

A 3-year-old girl is brought to your office by her mother because she has a fever and complains that her ear hurts. She has no significant medical his tory. The child is not pleased to be in the physician's office and has been crying. Her mother explains that she developed a "cold" about 3 days ago w ith sniffles. Her temperature is 37.8 degreesC (100 degreesF), and the rest of the physical examination is completed with some difficulty. The only ab normalities are slight redness of the throat. a nose full of thick green mu cus, and injected tympanic membranes. You wonder what findings other than r ed tympanic membranes should lead you to diagnose otitis media and also con sider the recent controversy about whether to treat acute otitis media (AOM ) with antibiotics.