The classic triad of otitis media includes which symptoms?

• A. Cough, sore throat, and runny nose
• B. Ear pain (otalgia), fever, and bulging tympanic membrane
• C. Hearing loss, dizziness, and nausea
• D. Ear irritation, red tympanic membrane only

Answer: (B)

The main idea here is recognizing the classic presentation of acute otitis media, a middle ear infection. The best answer reflects the triad clinicians look for: ear pain (otalgia), fever, and a bulging tympanic membrane due to pus and fluid behind the eardrum increasing pressure.

Ear pain happens from inflammation and pressure in the middle ear irritating nerves. Fever is a common systemic response to infection. The bulging tympanic membrane is a key physical finding: the fluid-filled middle ear pushes the TM outward, making it appear enlarged and often erythematous, and it typically shows reduced mobility on pneumatic otoscopy.

Why the other options don’t fit this classic triad: symptoms like cough, sore throat, and runny nose are common with upper respiratory infections and aren’t specific signs of middle ear involvement. Hearing loss, dizziness, and nausea can occur with ear problems but aren’t the defining triad of acute otitis media. Redness of the tympanic membrane without bulging suggests inflammation from other causes and isn’t as specific for AOM as a bulging TM with accompanying otalgia and fever.

So, the combination of ear pain, fever, and a bulging tympanic membrane best identifies the classic presentation.