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