• Ear pain
• Irritability
• Full sensation in the ear
• Fever
• Drainage
• Pulling at the ear in small children (direct correlation between pulling at the ears and infection is uncertain)

Patient will be referred to primary care provider if:

• Fever with with severely ill appearance
• Listless or screaming, not consolable due to pain
• Unable to eat or drink
• Stiff neck
• More than four visits in the last 12 months
• Have an immunocompromised condition