Ear Infection Diagnosis

If you suspect that you or your child has an ear infection, you should seek diagnosis and treatment from a healthcare provider.

Do I have an ear infection?

In order to begin diagnosing your condition, he or she will likely inspect your ears, throat, and nasal passage with a lighted instrument called an otoscope. He or she will also likely listen to your child’s breathing with a stethoscope.

Testing for ear infection

There are multiple types of examinations that your healthcare provider may perform in order to properly diagnose your condition. The most commonly used preliminary test is called a pneumatic otoscope. In this test, a provider uses a specialized tool to look in the ear and check for the presence of fluid behind the eardrum. The pneumatic otoscope allows him or her to gently puff air against the eardrum. While the eardrum would normally move in response to this air, the presence of fluid in the middle can cause the eardrum to move very little or not at all. If your provider is unsure about your diagnosis, if your infection hasn’t improved with treatment, or if there are other serious long-term problems, he or she may opt for additional testing. Other testing for ear infections includes:

• Tympanometry: This test measures the movement of the eardrum. The device used in a tympanometry seals off the ear canal and adjusts the air pressure within it. The device then measures how well the eardrum moves, providing an indirect measurement of the pressure within the middle ear.
• Acoustic reflectometry: This test measures how much sound is reflected back from the eardrum, providing an indirect measurement of the amount of fluids accumulated in the middle ear. While the eardrum normally absorbs most of the sound, the more fluid is present in the middle ear, the more sound the eardrum will reflect.
• Tympanocentesis: This test, while rare, is most helpful when an infection has not responded well to previous treatment. During the procedure, a healthcare provider uses a tiny tube to pierce the eardrum and drain fluid from the middle ear. This fluid is then tested for the presence of viruses and bacteria.

If your child has had multiple ear infections or a buildup of fluid in the middle ear, you may be referred to a hearing specialist (audiologist), speech therapist, or developmental therapist to be tested for hearing abilities, speech skills, language comprehension, or other developmental abilities.

Testing for swimmer’s ear

Swimmer’s ear is most commonly diagnosed based on your reported symptoms, your responses to a healthcare provider’s questions, and an office examination. You most likely won’t require a lab test during your first visit. The initial evaluation for swimmer’s ear usually includes:

• Examining the ear canal with a lighted instrument (otoscope). Your ear canal might appear red, swollen, and scaly and might contain skin flakes or debris.
• Inspecting your eardrum (tympanic membrane) to detect tears or damage. If the eardrum appears blocked, a provider may clear the ear canal with a small suction device or an instrument that will scoop out the blockage.

Depending on the initial assessment, the severity of your symptoms, or the progression of your swimmer’s ear, your provider may recommend additional evaluation, such as testing a sample of fluid from your ear for the presence of bacteria or fungi. Whether you suspect yourself of having an ear infection or swimmer’s ear, it is best to seek advice and treatment from a healthcare provider as quickly as possible.

Are ear infections contagious?

Ear infections are not contagious^[16]. While otitis media can result from contagious diseases like the common cold or the flu, the ear infection itself cannot be spread from person to person. In order to prevent catching upper respiratory infections that may lead to an ear infection, you should practice the following:

• Maintain good hygiene: Make sure that you and your child wash your hands with warm, soapy water after coughing or sneezing, and before preparing food or eating. If soap and water are not available, use an alcohol-based hand sanitizer.
• Stay at home when you are sick, and keep children out of school, daycare, or other group activities if they have an illness.
• Avoid close contact: Do not hug, kiss, or shake hands with others when either of you are sick.
• Practice respiratory etiquette: Cover your nose and mouth with your elbow (not your hand) when coughing or sneezing. Always use a tissue when possible.
• Disinfect surfaces: Disinfect kitchen and bathroom surfaces and frequently used objects (such as toys and doorknobs), especially when you or your family members are sick.
• Don’t share drinking glasses, utensils, or food with people close to you when either of you are sick.
• Avoid illnesses: Avoid close contact with anyone who is sick with a viral or bacterial infection.
• Take care of yourself: Eating well, sleeping sufficiently, and getting exercise may help keep you from getting sick.

Swimmer’s ear, like otitis media, is not contagious—the condition cannot be caught from someone who has the condition.

Baby ear infection

Ear infections, or acute otitis media (AOM), are a very common reason for young children visiting healthcare providers. While common, ear infections should always be treated. Chronic (frequent or long-lasting) ear infections can cause difficulty hearing, which may hinder speech development. In severe cases, chronic ear infections can lead to hearing loss. Children between the ages of 6 months and 2 years old are more susceptible to ear infections because of the size and shape of their eustachian tubes, and because their immune systems are still developing. Most children stop getting ear infections by the age of 6. It can be difficult to determine whether a child has an ear infection when he or she is too young to communicate what’s wrong. You should keep an eye out for possible ear infection when your child comes down with a fever, is irritable, or indicates pain in the ear. If your child isn’t old enough to tell you that he or she has ear pain, you can look out for these indications of a possible ear infection:

• Tugging or pulling at the ear
• Crying more than usual
• Drainage of fluid from the ear
• Trouble sleeping
• Difficulties with balance
• Hearing problems

Some young children may also experience nausea, vomiting, and diarrhea. If you suspect that your child has an ear infection, it’s important that you take him or her to a healthcare provider as quickly as possible.

Treating ear infection in young children

In some children, ear infections will get better without antibiotics and with no complications. The practice used to monitor an illness is called “watchful waiting.” This practice reduces the use of unnecessary antibiotics, which can lead to developing antibiotic resistance^[17]. However, it should be noted that watchful waiting is recommended for only 48–72 hours. If your child’s condition worsens, it is crucial that you discuss treatment plans and options with your healthcare provider, who will determine whether or not continued watchful waiting or antibiotic treatment will be best for your child. This determination is based on many factors, including the child's age, symptoms, severity, etc. If antibiotics are prescribed, follow all directions for the dosage and frequency when giving your child an antibiotic. It’s important that you do not skip doses and complete the entire treatment regimen, even if your child’s condition appears to improve.