Diagnosis of Middle Ear Infection
by Alayne Ronnenberg, ScD
You will be asked about your child's symptoms and medical history. A physical exam will be done. When there is ear pain or drainage from the ear, then infection is likely to be present. If the child is too young to report pain, the doctor or nurse practitioner must rely solely on looking into the child's ear with a lighted instrument, called an otoscope. The eardrum may be red, have pus behind the eardrum, and bulge outward because the fluid behind it is under pressure. A small tube and bulb (insufflator) may be attached to the otoscope so that a light puff of air can be blown into the ear. This helps the doctor see if the eardrum is moving normally. When infection is present the eardrum is often stiffened by the presence of fluid behind it and does not move. A red, bulging drum that does not move with an air puff is a very good sign that acute otitis is present.
Unfortunately, it is often difficult to see the eardrum in very young children, and ear wax frequently makes getting a good view of the drum next to impossible. Worse, even in the absence of wax, the accurate diagnosis of middle ear infection using an otoscope is not easy. Most studies suggest that even experienced doctors may overdiagnose acute ear infections, especially if an air puff insufflator is not used. Doctors may have a particularly difficult time distinguishing between children with chronic otitis (who frequently do not need antibiotics) and those with acute otitis (for whom antibiotics are often helpful). The use of a microscope to examine the ear may also help.
Your child may be referred to a specialist for further evaluation.
Tests may include:
Acute otitis media (AOM). EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated May 17, 2016. Accessed September 27, 2017.
Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at:
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Updated May 12, 2017. Accessed September 27, 2017.
Middle ear infections. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Middle-Ear-Infections.aspx. Updated February 22, 2013. Accessed September 27, 2017.
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999.
Last reviewed September 2018 by EBSCO Medical Review Board Marcie L. Sidman, MD
Last Updated: 9/17/2014
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