Diagnosing Ear Infections

September 07, 2008

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Diagnosing Ear Infections

by Jerome O. Klein, M.D.
reviewed and revised by Lynn Cates, M.D., F.A.A.P. and Laura Jana, M.D., F.A.A.P.

Although some companies advertise equipment to help parents identify ear infections at home, it's important that an experienced healthcare provider to examine children for ear infections because they can be difficult to diagnose, and the child may have additional--potentially more serious--problems, such as such as pneumonia, bloodstream infections (bacteremia or sepsis), or meningitis, which could require more aggressive therapy.

Healthcare providers use three main criteria for diagnosing acute middle ear infections (or acute otitis media):

Signs of acute (recent onset) illness. These can consist of either ear symptoms (e.g., ear pulling) or general symptoms (e.g., fever, fussiness, decreased appetite) that can begin hours to days before the illness is full blown. You should be sure to tell your child's provider about any symptoms you have noticed.

The presence of middle ear fluid. This fluid can be identified by your child's provider using instruments like a tympanometer or an otoscope (see below).

The presence of inflammation of the eardrum. The inflammation is identified by seeing redness and/or distortion of the landmarks of the eardrum (or tympanic membrane) with an otoscope.

An otoscopic examination involves looking at the contents of the middle ear through the eardrum. While this can be difficult to do with a squirming infant, it generally can be accomplished quickly by the experienced provider with minimal discomfort for the child (the parent often suffers more!).

Wax (cerumen) in the ear canal actually poses a more complex problem in some cases, since it may block the view of the eardrum. Practitioners can remove the wax with a curette (an instrument with a tiny spoon at the end that can be carefully inserted into the ear canal to remove earwax), or they can flush the canal with water. Sometimes it may be difficult or impossible to remove the wax. In these cases the healthcare provider may have to diagnose otitis media based on examination of only one of the ears, or he may even have to rely on suspicious indirect evidence of an ear infection (e.g., fever plus ear pulling) if he can't visualize the eardrums through the wax.

Other examination instruments
Healthcare providers also may use other instruments to help diagnose middle ear fluid. The tympanometer differentiates air-filled (normal) middle ear space from fluid-filled (abnormal) space by means of a sonar-like capability.

The acoustic reflectometer also differentiates air- from fluid-filled spaces, but it uses a different physical principal: the reflection of sound from the tympanic membrane.


RELATED INFORMATION

			Understanding Ear Infections: Anatomy of the Ear
			What To Expect With Treatment For Ear Infections
			Ear Infections

Created January 19, 2001
Reviewed and revised February 22, 2001

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