Ear infection (middle ear) - Diagnosis and treatment (2023)

Diagnosis

Your doctor can usually diagnose an ear infection or another condition based on the symptoms you describe and an exam. The doctor will likely use a lighted instrument (an otoscope) to look at the ears, throat and nasal passage. He or she will also likely listen to your child breathe with a stethoscope.

Pneumatic otoscope

An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to diagnose an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum.

Additional tests

Your doctor may perform other tests if there is any doubt about a diagnosis, if the condition hasn't responded to previous treatments, or if there are other long-term or serious problems.

  • Tympanometry. This test measures the movement of the eardrum. The device, which seals off the ear canal, adjusts air pressure in the canal, which causes the eardrum to move. The device measures how well the eardrum moves and provides an indirect measure of pressure within the middle ear.
  • Acoustic reflectometry. This test measures how much sound is reflected back from the eardrum — an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs most of the sound. However, the more pressure there is from fluid in the middle ear, the more sound the eardrum will reflect.
  • Tympanocentesis. Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid from the middle ear — a procedure called tympanocentesis. The fluid is tested for viruses and bacteria. This can be helpful if an infection hasn't responded well to previous treatments.
  • Other tests. If your child has had multiple ear infections or fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist for tests of hearing, speech skills, language comprehension or developmental abilities.

What a diagnosis means

  • Acute otitis media. The diagnosis of "ear infection" is generally shorthand for acute otitis media. Your doctor likely makes this diagnosis if he or she sees signs of fluid in the middle ear, if there are signs or symptoms of an infection, and if symptoms started relatively suddenly.
  • Otitis media with effusion. If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are presently no signs or symptoms of infection.
  • Chronic suppurative otitis media. If the doctor makes a diagnosis of chronic suppurative otitis media, he or she has found that a long-term ear infection resulted in tearing of the eardrum. This is usually associated with pus draining from the ear.

Treatment

Some ear infections resolve without antibiotic treatment. What's best for your child depends on many factors, including your child's age and the severity of symptoms.

A wait-and-see approach

Symptoms of ear infections usually improve within the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach as one option for:

  • Children 6 to 23 months with mild middle ear pain in one ear for less than 48 hours and a temperature less than 102.2 F (39 C)
  • Children 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

Some evidence suggests that treatment with antibiotics might be helpful for certain children with ear infections. On the other hand, using antibiotics too often can cause bacteria to become resistant to the medicine. Talk with your doctor about the potential benefits and risks of using antibiotics.

Managing pain

Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following:

  • Pain medication. Your doctor may advise the use of over-the-counter acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve pain. Use the drugs as directed on the label. Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin because aspirin has been linked with Reye's syndrome. Talk to your doctor if you have concerns.
  • Anesthetic drops. These may be used to relieve pain if the eardrum doesn't have a hole or tear in it.

Antibiotic therapy

After an initial observation period, your doctor may recommend antibiotic treatment for an ear infection in the following situations:

(Video) Middle Ear Infection (Acute Otitis Media) | Causes, Symptoms, Diagnosis, Treatment

  • Children 6 months and older with moderate to severe ear pain in one or both ears for at least 48 hours or a temperature of 102.2 F (39 C) or higher
  • Children 6 to 23 months with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)
  • Children 24 months and older with mild middle ear pain in one or both ears for less than 48 hours and a temperature less than 102.2 F (39 C)

Children younger than 6 months of age with confirmed acute otitis media are more likely to be treated with antibiotics without the initial observational waiting time.

Even after symptoms have improved, be sure to use the antibiotic as directed. Failing to take all the medicine can lead to recurring infection and resistance of bacteria to antibiotic medications. Talk with your doctor or pharmacist about what to do if you accidentally miss a dose.

Ear tubes

Tympanostomy tubes

Ear infection (middle ear) - Diagnosis and treatment (1)

Tympanostomy tubes

Ear tubes (tympanostomy tubes, ventilation tubes, pressure equalization tubes) are tiny cylinders, usually made of plastic or metal, that are surgically inserted into the eardrum. An ear tube creates an airway that ventilates the middle ear and prevents the accumulation of fluids behind the eardrum.

(Video) Middle Ear Infection (Otitis Media), Causes, SIgns and Symptoms, Diagnosis and Treatment.

If your child has certain conditions, your child's doctor may recommend a procedure to drain fluid from the middle ear. If your child has repeated, long-term ear infections (chronic otitis media) or continuous fluid buildup in the ear after an infection cleared up (otitis media with effusion), your child's doctor may suggest this procedure.

During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube (tympanostomy tube) is placed in the opening to help ventilate the middle ear and prevent the buildup of more fluids. Some tubes are intended to stay in place for four to 18 months and then fall out on their own. Other tubes are designed to stay in longer and may need to be surgically removed.

The eardrum usually closes up again after the tube falls out or is removed.

Treatment for chronic suppurative otitis media

Chronic infection that results in a hole or tear in the eardrum — called chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You may receive instructions on how to suction fluids out through the ear canal before administering drops.

Monitoring

Children who have frequent infections or who have persistent fluid in the middle ear will need to be monitored closely. Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests.

More Information

  • Ear tubes
(Video) Middle Ear Infections in Children | Merck Manual Consumer Version Quick Facts

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(Video) Ear Infections? Do This! | Dr K & Dr Wil

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Preparing for your appointment

You'll likely begin by seeing your family doctor or your child's pediatrician. You may be referred to a specialist in ear, nose and throat (ENT) disorders if the problem has persisted for some time, is not responding to treatment or has occurred frequently.

If your child is old enough to respond, before your appointment talk to the child about questions the doctor may ask and be prepared to answer questions on behalf of your child. Questions for adults will address most of the same issues.

(Video) Otitis Media: Anatomy, Pathophysiology, Risk Factors, Types of OM, Symptoms and Treatment, Animation

  • What signs or symptoms have you noticed?
  • When did the symptoms begin?
  • Is there ear pain? How would you describe the pain — mild, moderate or severe?
  • Have you observed possible signs of pain in your infant or toddler, such as ear pulling, difficulty sleeping or unusual irritability?
  • Has your child had a fever?
  • Has there been any discharge from the ear? Is the discharge clear, cloudy or bloody?
  • Have you observed any hearing impairment? Does your child respond to quiet sounds? Does your older child ask "What?" frequently?
  • Has your child recently had a cold, flu or other respiratory symptoms?
  • Does your child have seasonal allergies?
  • Has your child had an ear infection in the past? When?
  • Is your child allergic to any medication, such as amoxicillin?

By Mayo Clinic Staff

FAQs

How is middle ear infection diagnosed? ›

An instrument called a pneumatic otoscope is often the only specialized tool a doctor needs to diagnose an ear infection. This instrument enables the doctor to look in the ear and judge whether there is fluid behind the eardrum. With the pneumatic otoscope, the doctor gently puffs air against the eardrum.

Is a middle ear infection hard to diagnose? ›

It's not always easy to interpret what you see.

Many children are diagnosed with ear infections based solely on red ear drums. But that's not good enough. Ear drums, just like your child's face, turn red with fevers or screaming. That doesn't mean they are infected.

How is middle ear infection diagnosed in adults? ›

They will check the outer ear and the eardrum using an otoscope. This is a lighted tool that lets the healthcare provider see inside the ear. A pneumatic otoscope blows a puff of air into the ear to test eardrum movement. When there is fluid or infection in the middle ear, movement is decreased.

Can a doctor diagnose middle ear infection? ›

Treatment. A doctor can diagnose a middle ear infection by asking about symptoms and examining your child. The doctor will look inside your child's ear to examine the eardrum and look for pus in the middle ear.

How do you fix a middle ear infection? ›

A middle-ear infection may be treated with: Antibiotics, taken by mouth or as ear drops. Medication for pain. Decongestants, antihistamines, or nasal steroids.

How does a middle ear infection feel? ›

Symptoms of middle ear infections

Infection can cause: Earache – mild to severe pain in the ear or face or pulling at the ear and irritability in an infant. Fever – a high temperature might be the only symptom in babies or young children. Mild deafness – caused by fluid which builds up from the infection.

What is a test of the middle ear? ›

Tympanometry. Tympanometry tests how well your eardrum moves. The audiologist will put a small probe, which looks like an earphone, into each ear. A small device attached to the probe will push air into your ear. The person testing you will see a graph on the device, called a tympanogram.

Can an ENT see an inner ear infection? ›

Mostly, an ENT doctor will use an otoscope to view your eardrum and ear canal. This will allow them to see signs of infection and sometimes, a small blast of air is released into your ear to see how the eardrum reacts. This observation can help your ENT doctor to diagnose your ear infection.

What is the difference between an ear infection and a middle ear infection? ›

With swimmer's ear the pain is located in the outer ear canal, or the area near the ear opening, and increases when you pull on the earlobe. In a middle ear infection, pain is located in the inner ear, near the ear drum and will often increase with lying down, which can also cause trouble sleeping.

Will middle ear infection go away? ›

How Long Do Ear Infections Last? Middle ear infections often go away on their own within 2 or 3 days, even without any specific treatment. Often, there's fluid in the middle ear even after an infection clears up. If it's there for longer than than 3 months, more treatment might be needed.

What causes middle ear infection? ›

Most middle ear infections occur when an infection such as a cold, leads to a build-up of mucus in the middle ear and causes the Eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked.

What happens if an inner ear infection goes untreated? ›

Left untreated, an inner ear infection can damage your vestibular system, which controls balance. In these cases, recovery may last longer. Additionally, an unchecked inner ear infection could lead to permanent partial or total hearing loss. It's important to see a healthcare provider at the first sign of problems.

What medicine is good for inner ear infection? ›

Here are some of the antibiotics doctors prescribe to treat an ear infection: Amoxil (amoxicillin) Augmentin (amoxicillin/potassium clavulanate) Cortisporin (neomycin/polymxcin b/hydrocortisone) solution or suspension.

Is there a test for inner ear infection? ›

Most of the time, no specific testing is needed to diagnose an inner ear infection. But if the diagnosis is a little less certain, it's possible that your provider will recommend an additional evaluation. This may include: Imaging of your head, such as a CT scan or an MRI.

What virus causes middle ear infection? ›

For children, the most common trigger of an ear infection is an upper respiratory viral infection, such as a cold or the flu. These disorders can make the Eustachian tube so swollen that air can no longer flow into the middle ear.

How long does it take for a middle ear infection to clear up with antibiotics? ›

How Long Does It Take for an Ear Infection to Clear Up? Many mild ear infections will clear up in two or three days. If antibiotics are prescribed, the course is usually 10 days. However, fluid in the ear may linger for a few weeks even after the infection clears up.

Are middle ear infections serious? ›

Chronic ear infections often respond to treatment. However, your child may need to keep taking medicines for several months. Chronic ear infections are not life threatening. However, they can be uncomfortable and may result in hearing loss and other serious complications.

What are some common middle ear problems? ›

The ear canal can be blocked by wax, infection, a tumor, or a foreign object. The eardrum can be injured or infected. Abnormal bone growth, infection, or tumors in the middle ear can block sound waves. Sound waves may not be processed correctly in the inner ear.

How is middle ear effusion diagnosed? ›

They will look at the eardrum for signs that there may be fluid behind it. They may order a test called tympanometry. It can diagnose otitis media with effusion. It can also help tell the amount and thickness of the fluid that is trapped.

Can a CT scan detect inner ear infection? ›

A CT scan of the head or mastoids may show that the infection has spread beyond the middle ear. Hearing tests may be needed.

Can inner ear problems be seen on an MRI? ›

Magnetic resonance imaging (MRI) scan

During initial investigation it is important to exclude many serious conditions which can cause vertigo or unilateral hearing loss and tinnitus. The scan looks for the presence of some of these illnesses. It can show the internal auditory canal and exclude the presence of tumours.

How do you know if you have inner ear inflammation? ›

The most common symptoms of labyrinthitis are:
  1. dizziness or feeling that everything around you is spinning (vertigo)
  2. feeling unsteady and off balance – you might find it difficult to stay upright or walk in a straight line.
  3. feeling or being sick.
  4. hearing loss.
  5. ringing in your ears (tinnitus)

When should I worry about a middle ear infection? ›

Call your child's doctor if: Symptoms last for more than a day. Symptoms are present in a child less than 6 months of age. Ear pain is severe.

Why are middle ear infections so painful? ›

This type of ear infection happens when viruses or bacteria get into the middle ear — the space behind the eardrum. The middle ear fills with pus or infected fluid. The pus pushes on the eardrum, which can be very painful.

Is middle ear infection viral or bacterial? ›

Viral or bacterial infections can occur in the middle of the ear. These often cause pain, inflammation, and fluid buildup. Around 75 percent of children will have at least one ear infection before they reach 3 years old. Ear infections are the most common reason that children visit doctors.

Can a middle ear infection spread to the brain? ›

The deadliest complication of otitis media is a brain abscess, an accumulation of pus in the brain due to an infection. The most common symptoms are headache, fever, nausea, vomiting, neurologic deficits and altered consciousness.

Where is a middle ear infection located? ›

The most common type of ear infection is called otitis media. It is caused by swelling and infection of the middle ear. The middle ear is located just behind the eardrum. An acute ear infection starts over a short period and is painful.

What are the 3 types of ear infection? ›

Types of ear infection include: otitis externa. otitis media – acute or chronic. serous otitis media.

When an ear infection is serious? ›

Seek emergency care if you have any of the following symptoms: Pain in an ear with or without fever. Itching of the ear or ear canal. Loss of hearing or difficulty hearing in one or both ears.

How do I know if my ear infection is bacterial or viral? ›

Ear pain and new onset fever after several days of a runny nose is probably an ear infection.
...
Bacterial Infections
  1. Symptoms persist longer than the expected 10-14 days a virus tends to last.
  2. Fever is higher than one might typically expect from a virus.
  3. Fever gets worse a few days into the illness rather than improving.
21 Nov 2019

How long does it take for inner ear inflammation to go away? ›

It takes time for labyrinthitis symptoms to go away completely. Severe symptoms usually go away within a week. Most people are completely better within 2 to 3 months. Older adults are more likely to have dizziness that lasts longer.

What happens if antibiotics don't work for ear infection? ›

Ear infections that do not clear up after trying many antibiotics may need tubes. Prevention should be tried before turning to surgery. Talk to your child's doctor about when ear tubes are needed.

How does a middle ear infection make you feel? ›

The symptoms of an ear infection may include pain, tenderness, and hearing changes. Older adults may also experience balance problems and vertigo. Since an ear infection in adults can lead to serious health issues, it is important to see a doctor for treatment.

Is a middle ear infection visible? ›

Diagnosing a middle ear infection

While the area around the eardrum will most likely be red and swollen, this will normally only be noticeable upon examination with an otoscope. The ear itself will generally not be red or swollen.

What tests are used to assess middle ear function? ›

Tympanometry tests how well your middle ear works by measuring eardrum movement. Both tests can help a healthcare provider diagnose problems related to hearing loss. Tympanometry is a quick and easy test that shows how well your middle ear is working.

How long does a middle ear infection usually last? ›

Most middle ear infections (otitis media) clear up within three to five days and don't need any specific treatment. You can relieve any pain and a high temperature using over the counter painkillers such as paracetamol and ibuprofen.

What antibiotics are used for middle ear infection? ›

Here are some of the antibiotics doctors prescribe to treat an ear infection:
  • Amoxil (amoxicillin)
  • Augmentin (amoxicillin/potassium clavulanate)
  • Cortisporin (neomycin/polymxcin b/hydrocortisone) solution or suspension.
  • Cortisporin TC (colistin/neomycin/thonzonium/hydrocortisone) suspension.
26 Nov 2018

How are middle ear infections treated in adults? ›

Dr. Wang: Frontline treatment for middle ear infections is a course of oral antibiotics. Sometimes steroids can be added if the pain is severe, which doesn't help resolve the infection any faster but can reduce the inflammation and pressure causing the pain.

Will a middle ear infection go away by itself? ›

How Long Do Ear Infections Last? Middle ear infections often go away on their own within 2 or 3 days, even without any specific treatment. Often, there's fluid in the middle ear even after an infection clears up. If it's there for longer than than 3 months, more treatment might be needed.

What is the primary tool in the diagnosis of middle ear effusion? ›

However, for OME and AOM, pneumatic otoscopy is recommended as the primary tool for diagnosis of middle ear effusion.

How does an ENT check your ears? ›

During an ear exam, your ENT doctor will use a specialised tool called an otoscope to thoroughly check the outer canal of your ear and the eardrum. He will place the tip of the otoscope into your ear and shine a light into your ear canal, down to your eardrum.

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