“…When the diagnosis of AOM was confirmed, conservative or expectant treatment was followed in mild cases and antibiotics were administered in cases of increased risk, such as in children under 2 years of age, bilateral AOMs, and those with increased general affectation. It was defined as rhino-sinusitis to the persistence of daytime or rhinosherhorrhone cough for more than ten days, with no apparent improvement, in the context of an upper respiratory infection [17]. Persistent nasal obstruction was defined as difficulty breathing properly nasally, with associated respiratory symptoms, such as oral breathing, snoring, difficult breathing in sleep, stopping respiratory sleep (apnea), agitated sleep, neck stresses to sleep, drowsiness or feeling of not having rested properly, adenoid facies and swallowing difficulties [18].…”