Diagnosing acute otitis media (AOM) is quite challenging for physicians and especially other healthcare providers. Although the new guidelines from the American Academy of Pediatrics/American Academy of Family Physicians provide some guidance for making the correct diagnosis of AOM, overdiagnosis will still remain a problem. Physicians should pay meticulous attention to details of the visual examination of the tympanic membrane to avoid misdiagnosing and subsequent overprescribing antibiotics. To optmize the diagnostic accuracy in differentiating AOM from otitis media with effusion (OME), physicians must ensure that otoscopes, curettes, nickel-cadmium otoscope batteries, original specula, and other instruments are well maintained and appropriately and properly used. Implementing these recommended practices can reduce the uncertainty that typically arises in diagnosing AOM. This paper also addresses questions that can arise when applying guideline criteria.