Ear infection (middle ear)

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.

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:

• 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

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.

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.

• 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?