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Pediatr Infect Dis J. 2019 Dec;38(12S Suppl):S3-S9. doi: 10.1097/INF.0000000000002429.

Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Diagnosis.

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From the Department of Human Health Sciences, University of Florence, AOU Firenze, Florence.
Primary care paediatrician, Chioggia, Venice.
Primary care paediatrician, Florence.
Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia.
Università degli Studi di Roma "La Sapienza" UOC di Pediatria e Neonatologia, Polo di Latina, Roma.
Dipartimento sociosanitario di base cure primarie, ATS Città Metropolitana di Milano, Milan.
Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì.
Otorhinolaryngology Unit, Department of Health Sciences, University of Milan, Milan.
Department of Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric highly intensive care unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.



In recent years, new progress has been made regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society therefore decided to issue an update to the previous guidelines published in 2010.


Literature searches were conducted on MEDLINE by Pubmed, including studies in children, in English or Italian, published between January 1, 2010, and December 31, 2018. The quality of the included studies was assessed using the grading of recommendations, assessment, development and evaluations (GRADE) methodology. In particular, the quality of the systematic reviews was evaluated using the AMSTAR 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts.


The diagnosis of AOM is based on acute clinical symptoms and otoscopic evidence; alternatively, the presence of otorrhea associated with spontaneous tympanic membrane perforation allows the AOM diagnosis. The diagnosis of AOM must be certain and the use of a pneumatic otoscope is of fundamental importance. As an alternative to the pneumatic otoscope, pediatricians can use a static otoscope and a tympanometer. To objectively establish the severity of the episode for the formulation of a correct treatment program, an AOM severity scoring system taking into account clinical signs and otoscopic findings was developed.


The diagnosis of AOM is clinical and requires the introduction of specific medical training programs. The use of pneumatic otoscopes must be promoted, as they are not sufficiently commonly used in routine practice in Italy.

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