Diagnosis of acute otitis media is difficult: circumstances and equipment for diagnosis are often compromised, the child may be uncooperative, signs and symptoms of acute otitis media and those of the common cold are mostly the same, and parents appear to have strong opinions concerning correct diagnosis and treatment. Many clinicians have received inadequate pre- and postgraduate education about diagnosis. On the other hand, they are aware of the worldwide problem of antimicrobial resistance resulting from antibiotics unwisely prescribed for viral infections. We performed a systematic search to summarize what is known about diagnosis of acute otitis media and suggest ways to improve one's diagnostic skills. With the combination of appropriate and well-maintained diagnostic equipment for tympanometry and pneumatic otoscopy, strict diagnostic criteria, and open communication with each child's parents it is possible to increase accuracy in acute otitis media diagnosis. Recent public health campaigns both among clinicians and parents, plus increased knowledge of diagnostics reveal the possibility of significantly decreasing the number of acute otitis media diagnoses in children which will lead to reduced prescription of antibiotics.