Diagnosis begins with the collection of a thorough medical history. The physician will ask detailed questions regarding the patient’s symptoms, as well as their history of ear-related conditions and personal and family history of allergic conditions. A physical examination, focusing on the patient’s ears, nose and throat, will follow. The physician often uses an otoscope to search for signs of eustachian tube blockage, such as air bubbles or fluid behind the eardrum.

Most children with an ear-related condition such as otitis media will have rhinitis so it becomes important to distinguish between whether the condition is related to an infection or an allergy. The following might indicate a diagnosis of infection:

• Fever
• Malaise (general ill feeling)
• Profuse active rhinorrhea (runny nose)
• Presence of same illness in immediate family members
• Pus associated with rhinorrhea or pharyngitis (inflammation of the pharynx, a tube located between the mouth and the esophagus)

On the other hand, the following might indicate a diagnosis of allergy:

• Prolonged seasonal or perennial rhinitis with itching and sneezing
  
  
• Red, itchy, swollen eyes
  
  
• “Popping” or “snapping” sounds in the ears
  
  
• Hearing loss, ear discomfort, tinnitus (ringing in the ears) or vertigo
  
  
• Family history of allergy
  
  
• Seasonal runny nose or constant “cold”
  
  
• Accompanying symptoms of atopic dermatitis and allergic asthma
  
  
• Older age (e.g., school age)

Pneumatic otoscopy can be used to confirm suspicions that a patient may have fluid in the middle ear as a result of eustachian tube blockage. This procedure allows a physician to visually examine a patient’s eardrum (tympanic membrane) to see how well it moves in response to pressure changes inside the ear. Poor movement indicates that fluid is behind the middle ear. Discoloration of the eardrum also may indicate an ear infection.

Tympanometry is a more precise test of a patient’s eardrum function. During the test, a probe is placed inside the ear and an airtight seal is created. Air pressure inside the ear then is increased and decreased at intervals to detect how well the eardrum responds. The results are recorded in a machine called a tympanometer.

If otitis media with effusion has been present for longer than three months, a hearing test may be performed. If hearing is abnormal in at least one ear, antibiotic therapy may be considered. If hearing loss is detected in both ears, antibiotic therapy will be recommended.

If an allergy is the suspected cause of an ear-related condition, the following allergy tests may be performed:

• Skin testing. A small amount of an allergen is introduced to the patient’s skin to determine if the person is allergic to that allergen. After a period of time, the skin is examined for reactions to any of the allergens. If a rash or small bump develops, the patient is most likely allergic to that substance.
  

  

  
  
• Allergy blood tests. A sample of the patient’s blood is tested for substances that indicate an allergic reaction has occurred to a specific allergen. The most commonly used blood test for allergy-related conditions is the radioallergosorbent test (RAST).
  
  
• Food allergy tests. Patients may be asked to avoid (or, in rare cases, to ingest) specific foods according to a timetable to determine if allergic reactions can be avoided.
  
  
• Other related tests. Any number of tests that may be used in diagnosing the causes of allergy-related symptoms, including those to determine lung or nasal function and to rule out other causes of allergy-like symptoms (such as infection). Additional tests may include nasal smear, nasal endoscopy or x-rays of the chest, nose or sinuses.