To the Editor.—

In the May 2004 issue of Pediatrics, the Subcommittee on Management of Acute Otitis Media published its long-awaited clinical practice guideline, updating our understanding of this complex process.

The guideline is very helpful in pointing out the importance of pain management and reviewing strategies for more effective pain relief. Adopting preventive strategies to reduce the frequency of acute otitis media (AOM) is another important contribution. The most difficult and contentious recommendations made by the subcommittee involve criteria necessary for the accurate diagnosis and treatment of AOM.

An important stated mission of the diagnostic component of the guideline is to reduce overdiagnosis of AOM. The first guideline recommendation concerns the elements of the history and physical examination needed to diagnose AOM accurately. The guideline co-chair, Allan S. Lieberthal, MD, is quoted in the September 2004 issue of Infectious Diseases in Children as stating: “The most...

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