Acute otitis media has changed conceptually from being a feared infection with severe complications to a modest disease that should be treated for symptomatic relief but often without immediate antimicrobials. This holds true for infants and children with nonsevere forms of the illness if the parents and the clinician agree to a strategy of watchful waiting with easy access for follow-up. Accurate otologic examination is critical for disease recognition, but the initial choice of treatment must also consider the general impact that the disease produces in each individual patient. The appraisal of the symptoms that characterize the illness in a child, matched with the otoscopic intensity of the disease, provide a comprehensive estimation of overall severity that many experts have used for research. The perspectives examined in this article and the schematic construct that proposes considering disease and illness independently may help to bring the current paradigm of acute otitis media into everyday pediatric practice as a model for a more rational and personalized management of each patient.