Parents should contact a pediatrician if they suspect their child has an ear infection or other ear-related problem. Because ear problems in infants often have nonspecific symptoms, the diagnosis can be a little complicated. Diagnosing the problem may involve a complete medical history, including a description of the type, severity and duration of symptoms, and a physical examination. 

During the physical examination, a physician will likely use an instrument called an otoscope to examine the ear canal and eardrum (located at the innermost end of the ear canal). A physician will look for any signs of swelling, redness or debris in the ear canal.

A bulb may be attached to the otoscope that can push air into the ear canal to test the mobility of the eardrum. A middle ear infection – in which fluid or pressure in the middle ear presses against the eardrum – can restrict movement of the eardrum. A bulging or red eardrum may also indicate the presence of a middle ear infection.

In order to confirm a middle ear infection (otitis media), a sample of fluid from the middle ear must be analyzed. However, this is not often practical since it requires piercing the eardrum with a small needle to get to the fluid on the other side of the eardrum. Young children may not be able to remain still during this test, and this sampling is not often done. Generally, signs of a middle ear infection are enough for a physician to diagnose the illness. In 2004, the American Academy of Pediatricians issued the following guidelines for the diagnosis of middle ear infection:

• Recent onset of signs and symptoms of middle ear inflammation

AND

• Any of the following:
  • Bulging of the ear drum
  • Limited mobility in the ear drum
  • Air fluid level behind the tympanic membrane
  • Drainage from the ear

AND

• Either:
  • Redness of the ear drum OR
  • Ear pain

If there is a discharge from an ear, a sample of this fluid may be taken with a cotton swab and analyzed. This can identify the bacteria or fungi responsible for an outer ear infection (swimmer’s ear).  

A physician may also examine the throat and nose for signs of other infections, such as a cold or the flu. If there are any foreign objects lodged in the ear canal, the physician may remove the item during the examination. In rare cases, surgery may be required to remove the object.

Additional devices that may be used during an examination include a tympanogram (analyzes the mobility of eardrum) and an acoustic reflectometry monitor (measures fluid buildup in the middle ear).

Infants and young children with recurrent middle ear infections should periodically have their hearing tested. Hearing loss can occur as a result of chronic ear infections and may delay speech and language development in young children. A hearing test such as an audiogram (uses tones at varying frequencies to identify hearing loss) may be used after a child is treated for an ear infection.