In comparison to cerumen impaction, patients experiencing acute otitis media typically present with which symptoms that aid in ruling the patient out for self-care treatment? SELECT ALL THAT APPLY

A. Ear fullness: Ear fullness can occur in both cerumen impaction and acute otitis media (AOM). It is nonspecific and does not reliably differentiate between the two conditions, it does not rule out self-care. B. Ear itching: Ear itching is more characteristic of cerumen buildup or external ear irritation rather than AOM. It is not a distinguishing symptom that indicates a need for medical evaluation in the context of AOM. C. Abnormal drainage from ear: Purulent, bloody, or foul-smelling drainage is a hallmark of acute otitis media with tympanic membrane rupture or otitis externa. The presence of abnormal drainage suggests infection rather than simple cerumen impaction and indicates that self-care measures are inappropriate; professional medical evaluation is required. D. Ear pain: Moderate to severe ear pain, often acute in onset and sometimes accompanied by fever, is a primary symptom of AOM. Pain of this nature suggests an infectious etiology rather than a benign wax impaction and signals the need for medical intervention instead of self-treatment.