Acute otitis media (AOM) is a prevalent pediatric condition characterized by middle ear inflammation, often associated with effusion. It primarily affects infants and young children and is a leading cause of physician visits, antibiotic prescriptions, and potential complications if left untreated. Early diagnosis in infants is particularly challenging as they cannot verbalize their symptoms, and clinical presentations such as fever, irritability, and feeding difficulties are nonspecific. Parental observation of ear pulling or tugging has been noted anecdotally as a potential indicator of ear discomfort and AOM. However, there is limited data on its diagnostic accuracy. Investigating the utility of ear pulling as a screening sign could aid in early identification and timely management of AOM, reducing the risk of complications and unnecessary antibiotic use.

This study aims to evaluate the sensitivity, specificity, and predictive values of ear pulling in diagnosing AOM, correlating it with definitive otoscopic findings.

Main Objectives of study are to  assess the correlation between ear tugging and Acute Otitis Media, to evaluate sensitivity and specificity of ear pulling as a screening tool and to improve early diagnosis and intervention.

In this study, Infants presenting with fever, irritability, or unexplained crying will be screened for ear-pulling behavior. Parents will report observed behaviors such as ear tugging, rubbing, or crying when touching the ear. An Otorhinolaryngologist will perform otologic examinations using pneumatic otoscopy to confirm the diagnosis of AOM. A standardized case record form (CRF) will be used to document demographic data, clinical history, parental observations, otoscopic findings, and final diagnosis. Statistical analysis will be done in form of Descriptive statistics for demographic and clinical data, Diagnostic metrics (sensitivity, specificity, PPV, NPV) for ear pulling and Chi-square or Fisher’s exact test to assess the association between ear pulling and confirmed AOM cases.

Informed consent will be obtained from all parents or guardians, The study involves minimal risk as it relies on standard clinical examinations, Data confidentiality will be strictly maintained.

Ethical guidelines, including the Declaration of Helsinki, will be followed throughout the study.  Expected benefits to volunteers are there in this study as volunteers will be diagnosed timely and treated timely which is very beneficial for their own health.