The key factors in the history that support the diagnosis of AOM vary depending on the age of the patient. In an older, verbal child they include a preceding viral respiratory illness followed by the acute onset of otalgia. In a pre-verbal child, the key factors should include fever or systemic symptoms indicative of otalgia such as irritability, crying, sleep disturbance, vomiting, or poor appetite.

AOM occurs in less than 1% of adults. Adults typically present more quickly than children with complaints of ear pain, decreased hearing, sore throat, and otorrhoea. Nonetheless, adults have higher rates of persistent middle ear effusions or infections 2 months after initial diagnosis compared with children.[17] Bacteriology and treatment are similar to those for children.

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