Diagnosis and management of acute otitis media in Michigan.

We surveyed pediatricians (PEDs), family physicians (FPs), otolaryngologists (ENTs), and emergency physicians (ERs) from across Michigan (100 each), as well as 30 nationally recognized experts about their clinical approach to acute otitis media (AOM). The overall response rate was 52%. There was substantial variation within each group with respect to diagnostic criteria and clinical decision-making, but no significant differences among groups. The 63% of respondents who considered symptoms among their diagnostic criteria for AOM were 3.8-fold more likely to defer therapy for an asymptomatic toddler with a bulging, red, immobile tympanic membrane (TM) (95% Confidence Interval (CI) 1.53, 9.74), but 24% of respondents stated that they would prescribe oral antibiotics for a symptomatic child with a red TM, even in the absence of a middle ear effusion. These data suggest that diagnostic criteria are a major factor determining whether clinicians prescribe antibiotics to a particular patient.