The former is usually symptomatic, especially ear pain (otalgia), whereas the latter is most commonly without acute symptoms.
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Otalgiais not always associated with ear disease.
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Referredotalgiais ear pain that originates from outside the ear.
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Primaryotalgiais ear pain that originates inside the ear.
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Chronic otitis media usually presents in an ear with chronic discharge (otorrhea), or hearing loss, with or without ear pain (otalgia).
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