How Middle Ear Infections Are Diagnosed

An ear infection happens when the middle ear becomes inflamed and fluid builds up behind the eardrum. Five out of six children will have an ear infection by the time they are 3 years old, making it the most common reason parents bring their child to a healthcare provider.

This article discusses the causes, symptoms, and diagnosis of ear infections. It also includes information about other possible reasons you or your child may have ear pain and redness.

ear infection diagnosis


How Ear Infections Start

Ear infections often begin after a child has a cold, sore throat, or upper respiratory infection caused by common bacteria or viruses.

Behind your eardrum is a small chamber called the middle ear. Connected to the middle ear is your eustachian tube, which drains fluid into the back of your throat and ventilates the middle ear space. An infection can cause the eustachian tube to swell and block fluid from draining or allow negative pressure to build up.

As the fluid builds up in the middle ear, viruses or bacteria can grow, causing an infection in the middle ear. Children have narrower and shorter eustachian tubes than adults, making them more prone to ear infections.


Some ear infections may not cause symptoms at all and are only diagnosed when a healthcare provider notices fluid buildup behind the eardrum.

The most common type of ear infection is acute otitis media (AOM). Symptoms of AOM tend to come on suddenly.

Symptoms include:

  • Ear pain
  • Fever
  • Feeling dizzy or off-balance
    A child with AOM may be especially fussy and have difficulty sleeping. You may also see them rubbing or tugging at their ear.
  • In some cases, ear infections can cause hearing loss.

Early diagnosis and treatment of an ear infection may help prevent it from developing into a more serious illness. For 80% of children with AOM, symptoms completely resolve within three days without the need for antibiotic treatment.


In very severe cases of AOM that do not resolve, a child can develop meningitis, a condition in which the tissues surrounding the brain become inflamed.

Although rare, children can also develop a bacterial infection in the temporal bones that surround the ear canal. This condition is known as acute mastoiditis, and it is very rare.


Healthcare providers can safely examine ears for infection using an otoscope. This special tool has a light and a lens that help them see all the way to the eardrum without the risk of puncturing it. Usually, this exam is enough to make a diagnosis.

Visual Examination

Your healthcare provider will check to see if the eardrum appears cloudy, red, yellow, or swollen. Signs of fluid behind the eardrum or in the ear canal will confirm the diagnosis.

Between 5 and 10% of children will develop a small tear on the eardrum due to the infection, causing cloudy pus to drain from the ear.

Your healthcare provider may also use a small probe to lightly pulse sound waves against the eardrum. This test is known as tympanometry, and it shows your healthcare provider how well the eardrum moves in response to sound.


In most cases, imaging is not necessary to check for an ear infection. However, your healthcare provider may order imaging tests if the ear infection persists despite treatment or if there's a concern about complications or about a possible cholesteatoma.

Imaging may include:

  • Computed tomography scan (CT scan): A CT scan may be used to check for abscesses or other abnormalities in and around your ear.
  • Magnetic resonance imaging (MRI): If your healthcare provider suspects that your infection may have spread to your brain, they may order an MRI to take a detailed look at your brain.

Ear Infection Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Child


Ear infections may be caused by a viral or bacterial infection and often clear up on their own within three days. Healthcare provider use an otoscope to examine the ear for infection. A buildup of fluid in the middle ear and drainage of pus is consistent with an ear infection.

What Else Could It Be?

Many other conditions have similar symptoms as an ear infection. For this reason, you should avoid self-diagnosis and have your symptoms checked by a healthcare provider , especially if your symptoms last beyond three days.

The following symptoms can develop due to ear infections, as well as with other conditions:

  • Ear pain: Common causes of ear pain include swimmer's ear, ear trauma, or shingles. Children, in particular, may have ear pain if they get a small object stuck in their ears.
  • Redness: Redness may be caused by upper respiratory infection, crying, high fever, or ear trauma.
  • Decreased motion: If the healthcare provider finds that your eardrum does not move as it should in response to pressure, they may consider another condition like tympanosclerosis, in which calcium builds up on the eardrum.

When to See Your Healthcare Provider

Children younger than three months of age need to see a healthcare provider at the first sign of ear infection.

Older children should be seen if they have one or more of the following symptoms:

  • A fever of 102.2 degrees or higher
  • Discharge leaking from their ear
  • The symptoms get worse or do not resolve within three days
  • Hearing loss

Ear infection in adults may signify a more serious problem and should be checked by a healthcare provider. If the infection comes and goes, schedule an appointment with an otolaryngologist, a healthcare provider who specializes in ear, nose, and throat conditions.


Most cases of ear infections get better on their own without medication. Infections that are severe or persist beyond three days may be treated with an antibiotic like amoxicillin.

In the meantime, drinking plenty of water, applying a warm compress to the ear, and taking over-the-counter pain relievers like Tylenol (acetaminophen) or Advil (ibuprofen) can help ease the healing process along.


An ear infection typically begins after a cold, flu, or upper respiratory infection. The bacteria or virus that caused the infection may build up in fluid behind the eardrum, leading to a middle ear infection.

Ear infections are more common in children than adults. In children, the infection generally clears up within three days on its own. If it lasts longer, it should be checked out by a healthcare provider, who will use an otoscope to examine the ear.

A Word From Verywell

Figuring out if your child has an ear infection can be quite distressing, as young children can't always express what symptoms they are having. If something seems off with your child, take them to a healthcare provider.

Your healthcare provider may recommend using a warm compress and over-the-counter pain relievers. Typically, your child will be back to their usual self within a few days.

Frequently Asked Questions

  • How can you tell if you have a middle ear infection as an adult?

    The most common symptoms of ear infection in adults are:

    • Pain in one or both ears
    • Fluid draining from the affected ear
    • Hearing issues
    • Sore throat
    • Fever
    • Problems with balance
  • How can a healthcare provider tell the difference between a viral middle ear infection and a bacterial middle ear infection?

    The symptoms of a middle ear infection can e fairly similar whether they're caused by a virus or bacteria. Lab tests are rarely used to determine the cause. In many cases, both a virus and bacteria are involved.

9 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.
  1. National Institute on Deafness and Other Communication Disorders. Ear infections in children.

  2. Centers for Disease Control and Prevention. Ear infection.

  3. Venekamp R, Damoiseux R, Schilder A. Acute otitis media in children. Am Fam Phys.

  4. Seattle Children's. Ear infection questions.

  5. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):964-999. doi:10.1542/peds.2012-3488

  6. Earwood JS, Rogers TS, Rathjen NA. Ear pain: Diagnosing common and uncommon causes. Am Fam Physician.

  7. Columbia University Irving Medical Center. Middle ear infection in adults.

  8. Cedars-Sinai. Middle ear infection (otitis media) in adults.

  9. Merck Manual Professional Version. Otitis media (acute).

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.