Diagnosis is based on ear-related signs and symptoms. The child should not unnecessarily be labelled as a "chronic ear patient". The criteria for acute otitis media (AOM) are middle ear effusion bulging, cloudy, yellowish tympanic membrane with distorted or absent light reflex (pictures ) signs and symptoms of an acute infection. Redness alone is not a diagnostic finding (picture ). Diagnostic accuracy is greatly improved with the use of pneumatic otoscopy and tympanometry . It is normal that some middle ear effusion persists after AOM, even for several weeks . This must not be interpreted as a new episode of AOM. Wrong and uncertain diagnoses result in unnecessary courses of antibiotics and tympanostomy tube insertions.