How are ear infections diagnosed?

If an ear infection is suspected, consult a physician. The doctor will probably use an otoscope (a lighted instrument designed to examine the ear through the ear canal) to examine the ear canal and eardrum. The doctor will also examine the nose and throat. The bony part of the skull behind the ears (the mastoid) will be examined, too. Pain, redness, or tenderness of the mastoid can be a sign of a serious infection.

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Middle ear infections are usually diagnosed using a health history, a physical exam, and an ear exam.

• Pneumatic otoscope: If a middle ear infection is suspected, a healthcare provider will use a pneumatic otoscope (an instrument for looking into the ear that puffs air) to look at the eardrum for signs of redness or bulging. In the case of fluid buildup without infection (otitis media with effusion), the eardrum can look like it is bulging or sucking in. In both cases, the eardrum doesn't move freely when the pneumatic otoscope pushes air into the ear.
• Tympanometry: Tympanometry tests the movement of the eardrum. The tip of a hand-held tool is placed just inside the ear. It changes the air pressure inside the ear. Then, the tool measures how the eardrum responds. If the air pressure is not appropriate, then a ruptured ear drum may be present.
• Tympanocentesis: Tympanocentesis is performed when fluid stays behind the eardrum (chronic otitis media with effusion) or infection continues even with antibiotics. Tympanocentesis can remove the fluid. The doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is usually tested for bacterial or viral growth. These tests reveal what kind of bacteria or virus is causing the infection and which medication is best for treatment. The child may need analgesia or sedation before this procedure due to this being an uncomfortable procedure. Analgesia can be used when indicated with acetaminophen, with codeine (Tylenol #3®), or with diazepam (Valium®) for sedation. Side effects include drowsiness and sedation after the procedure is completed.
• Reflectometry: Reflectometry is used if the ear exam with a pneumatic otoscope does not indicate that fluid is behind the eardrum. The tip of a small handheld instrument is placed in the ear canal and sends off a sound. How the eardrum reacts to the sound tells the doctor if fluid is present.
• Blood tests, including white blood cell counts, can be used to determine if the immune system is functioning properly.

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Middle ear infections are usually diagnosed using a health history, a physical exam and an ear exam. 

The doctor uses a pneumatic otoscope to look at the eardrum for signs of an ear infection or fluid buildup. For example, the doctor can see if the eardrum moves freely when the pneumatic otoscope pushes air into the ear.

Other tests may include:

• Tympanometry, which measures how the eardrum responds to a change of air pressure inside the ear.

• Hearing tests. These tests are recommended for children who have had fluid in one or both ears (otitis media with effusion) for a total of 3 months. The tests may be done sooner if hearing loss is suspected.

• Tympanocentesis. This test can remove fluid if it has stayed behind the eardrum (chronic otitis media with effusion) or if infection continues even with antibiotics.

• Blood tests, which are done if there are signs of immune problems.