the ear canal (compared with older children) and may make recognition of the TM and its landmarks more difficult Amniotic fluid may be present in the middle ear cavity for days to weeks after birth and should not be confused with middle ear infection unless other symptoms such as fever and irritability are present A variety of scoring systems have been developed to aid in the diagnosis of AOM, though none have been formally recommended by the AAP FIGURE 118.2 Right tympanic membrane Management The clinical diagnosis of AOM is made clinically and no additional laboratory or imaging studies are necessary Antibiotics prescribed for AOM account for 25% to 50% of all outpatient antibiotics and are partly responsible for the global increase in antibiotic-resistant organisms, especially S pneumoniae, H influenzae, and M catarrhalis As such, expert panels and various medical