- Recent (<48 hours) onset of ear pain (otalgia), unilateral or bilateral, which may manifest in young or preverbal children as:
- Ear tugging, rubbing, or holding
- Irritability, excessive crying
- Difficulty sleeping
- Decreased eating
- Other behavioral changes such as decreased playfulness
- Fever
- Presence or ear discharge (otorrhea)
- Bulging or redness of the tympanic membrane upon inspection
- Hearing loss
- Vertigo
- Tinnitus or ringing in the ear
- Postauricular swelling
- Facial swelling in severe cases
- Conjunctivitis – caused by non-typeable H. influenzae and is referred to as otitis-conjunctivitis syndrome
