1)      Unilateral unexplained head and neck area pain > 1/12 associated with earache but normal otoscopy

2)      Mastoid swelling, tenderness (malignant otitis externa)

3)      Diabetes, immunocompromise (malignant otitis externa)

4)      Earache and cranial neuropathy (malignant otitis externa)

5)      Persistence and/or relapse of otitis externa symptoms

6)      Acute otitis media with facial nerve palsy (Acute mastoiditis)

7)      Acute otitis media with mastoid signs (like swelling, edema, redness and tenderness, anterior inferior displacement of the ear, high spiking fevers)(Emergency ENT referral)