Ear, Nose & Throat Ear Infections Ear Infections Guide Ear Infections Guide Symptoms Causes Diagnosis Treatment Coping and Caregiving How Middle Ear Infections Are Diagnosed By Kristin Hayes, RN facebook twitter Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children. Learn about our editorial process Kristin Hayes, RN Medically reviewed by Medically reviewed by Andy Miller, MD on July 14, 2019 Andy Miller, MD, is board-certified in internal medicine and infectious disease. He is an associate professor at Weill Cornell Medicine in New York City. Learn about our Medical Review Board Andy Miller, MD Updated on August 17, 2019 Print Table of Contents View All Table of Contents Self-Checks and At-Home Testing Visual Examination Imaging Differential Diagnoses Next in Ear Infections Guide How Middle Ear Infections Are Treated Properly diagnosing an ear infection, also known as acute otitis media (AOM), shortens the duration of discomfort, is important to avoid overuse of antibiotics, and helps to prevent worsening infection. Aside from a thorough health history, your physician will likely only need to use a pneumatic otoscope to diagnose an ear infection. Because young children can't always tell you what is wrong, finding out whether or not your child has an ear infection can be quite distressing as a parent. Fortunately, a trained physician can usually identify an ear infection without much difficulty. Also note that even if you didn't have an ear infection as a child, you can still get one as an adult. © Verywell, 2018 Self-Checks and At-Home Testing You do not need to be a doctor in order to purchase the supplies needed to do an effective ear exam. However, it is not encouraged unless you know what you are doing, as there are subtleties to assessing the tympanic membrane (as described below). Children also are notorious for not being cooperative during an ear exam. Without proper equipment and technique, there is a risk of accidentally perforating the eardrum if you insert anything too far into the ear. However, there are companies that are making it easier for a quick check that you may find helpful before visiting your doctor. There are some smartphone attachments that will allow you to visualize the ear canal and tympanic membrane. There have also been some devices developed that will try to provide a scale of the level of fluid behind your tympanic eardrum; though the accuracy seems to be questionable based on online reviews. Visual Examination During the visit with your doctor, it will be important for them to examine your ear. Otoscopy is an exam performed with an otoscope that will allow for the visualization of your external ear canal and your eardrum (tympanic membrane). While you can perform a basic assessment with a standard otoscope, it is best if your doctor has the pneumatic attachment for the otoscope. The pneumatic attachment is simply a rubber bulb that allows your doctor to apply light pressure to your tympanic membrane. Here is what your physician will be looking for in a normal eardrum: Position - the tympanic membrane will be in a flat or neutral position Translucency - the tympanic membrane is typically translucent Motion - the tympanic membrane will move with application of pneumatic pressure (both positive or negative pressure) from the bulb on the otoscope Color - the typanic membrane will appear pearly gray or pink Findings that are suggestive of abnormalities in your inner ear include: Position - the tympanic membrane is either bulging or retracted Translucency - the tympanic membrane is opaque or cloudy Motion - the tympanic membrane doesn't respond appropriately to pneumatic pressure when using the bulb on the otoscope Color - gray, blue, amber, white, or pale yellow are all abnormal colors associated with the tympanic membrane. Your physician will typically diagnose you with an ear infection if they see a bulging tympanic membrane. Ear Infection Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Imaging You will not need any imaging for a standard work-up of an ear infection. However, if the infection is prolonged and your doctor is worried about other complications, they may order a CT scan or an MRI. A CT scan can be useful in seeing the structures, abscesses, or other abnormalities around your ear. An MRI, on the other hand, is useful if your physician is concerned about any problems related to your brain. The use of CT or MRI would be rare and will not be part of a typical evaluation. Differential Diagnoses When assessing whether or not you have an ear infection, your doctor will try to differentiate if you have acute otitis media (ear infection) or otitis media with effusion (OME, non-infected fluid in the ear). Both can appear very similar. Color, motion, and translucency may be variable between both AOM and OME. However, the position of the tympanic membrane is generally the tell-tale sign. In AOM, the tympanic membrane is typically bulging, while it is usually retracted with OME. Other Possible Causes of Ear Pain Redness Redness of your tympanic membrane without signs of fluid behind the eardrum is not caused by an ear infection. Your physician may also look at these common causes of redness around the tympanic membrane: upper respiratory infection causing inflammation of the respiratory tract crying elevated fever ear trauma recent removal of ear wax Decreased Motion Testing for mobility of the tympanic membrane is important for the identification of middle-ear effusion (MEE - fluid in your middle ear). However, decreased mobility does not mean that the fluid in the middle ear is infected. Other causes of having decreased mobility of your tympanic membrane include: obstruction of the eustachian tube tympanosclerosis Ear Pain Having ear pain is a common symptom of an ear infection. However, there are many other reasons for experiencing ear pain including: otitis externa (swimmer's ear) ear trauma obstruction of ear canal with a foreign object temporomandibular joint syndrome herpes zoster (shingles) Because of the many different diagnoses that can occur with symptoms of an ear infection, it is always important to follow up with a physician for proper diagnosis. How Middle Ear Infections Are Treated Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Ponka D, Baddar F. Pneumatic otoscopy. Can Fam Physician. 2013;59(9):962. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-99. doi:10.1542/peds.2012-3488 Harmes KM, Blackwood RA, Burrows HL, Cooke JM, Harrison RV, Passamani PP. Otitis media: diagnosis and treatment. Am Fam Physician. 2013;88(7):435-40. Kashyap RC. Management of Common Otological Diseases at a Peripheral Medical Set Up. Med J Armed Forces India. 2003;59(4):332-6. doi:10.1016/S0377-1237(03)80148-X Earwood JS, Rogers TS, Rathjen NA. Ear Pain: Diagnosing Common and Uncommon Causes. Am Fam Physician. 2018;97(1):20-27. Additional Reading Acute otitis media in adults. UpToDate website. http://www.uptodate.com (subscription required). Updated April 19, 2017. Acute otitis media in children: Diagnosis. UpToDate website. http://www.uptodate.com (subscription required). Updated October 13, 2017.