Diagnosing AOM In Toddler

An 18-month-old toddler, Estaban, presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago. For the past 36 hours, his father reports increased crankiness and intermittent fever to 102.6°F (39.2°C), with the father stating, “This is how he acted a few months ago when he had an ear infection.” Which of the two following findings are most suggestive in the diagnosis of acute otitis media in a toddler?
A. Bulging tympanic membrane
B. Cough
C. Evidence of ear discomfort
D. Bilateral cervical lymphadenopathy