Final answer:
Patients with acute otitis media should be referred to a specialist if they have concurrent vertigo or ataxia, failed closure of ruptured TM, or if symptoms worsen after 3-4 days of treatment.
Step-by-step explanation:
Patients with acute otitis media should be referred to a specialist in all of the above situations.
Concurrent vertigo or ataxia can indicate a more serious ear condition that requires specialized evaluation. Failed closure of ruptured tympanic membrane (TM) suggests an underlying problem that needs expert assessment. If symptoms worsen after 3-4 days of treatment, it could indicate treatment failure or a need for further intervention. In all these situations, a specialist can provide the necessary expertise to manage the condition effectively.