Acute onset of symptoms

In younger children there may be signs of pain with the child holding, tugging, or rubbing the ear. Young children may also have non-specific symptoms such as fever, crying, poor feeding, restlessness, and behavioural changes and malaise. Vomiting may be a feature.

Bilateral otitis media (both ears) is more common in those aged under two years of age. Perforation of the eardrum often relieves pain. A child who is screaming and distressed may settle quickly when the ear starts to discharge pus.

Recurrence of AOM is common, particularly in children less than two years. The Clinical Pathway for Pharmacy First in England advises that those with three or more episodes in six months, or four or more episodes in 12 months should be referred.