Diagnosis of Middle Ear Infection

You will be asked about your child's symptoms and past health. A physical exam will be done. The doctor will ask about signs such as ear pain or drainage. An ear infection may be suspected based on symptoms. A scope may be used to look inside the ear. An infection will cause redness, swelling, or pus around the eardrum. A small puff of air may also be passed into the ear. The eardrum should move a bit with the air. Fluid or swelling around the eardrum will make the eardrum stiff. This would suggest an infection.

It may be hard to tell the difference between a new infection or one that has lasted some time. Treatment can differ between theses types.

Other tests may include:

  • Tympanometry —A soft plug is placed at the opening of the ear. It can measure movement of the eardrum.
  • Acoustic reflectometry—This test measures fluid in the middle ear.
  • Hearing test —A hearing test may be ordered in cases of repeat ear infections or if there are signs of hearing impairment, such as speaking in a louder voice, sitting closer to the television or turning up the volume.
  • Tympanocentesis —A needle is used to withdraw fluid or pus from the middle ear under local or general anesthesia. This fluid can then be cultured to determine if bacteria are present in the fluid. After the bacteria are cultured, the lab can determine which drugs are best for treatment. However, the fluid does not always have bacteria in it.


Acute otitis media (AOM) in Adults. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/acute-otitis-media-in-adults. Updated September 4, 2019. Accessed December 5, 2019.
Acute otitis media (AOM) in Children. EBSCO DynaMed website. Available at: https://www.dyname.... Updated September 4, 2019. Accessed December 5, 2019.
Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at:
...(Click grey area to select URL)
Updated May 12, 2017. Accessed December 5, 2019.
Lieberthal AS, Carroll AE, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013 Mar;131(3):e964-e999
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 December 5, 2019.
Last reviewed September 2019 by EBSCO Medical Review Board Nicole S. Meregian, PA
Last Updated: 8/25/2020

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

To send comments or feedback to our Editorial Team regarding the content please email us at healthlibrarysupport@ebsco.com. Our Health Library Support team will respond to your email request within 2 business days.