Parents are urged to consult a physician, preferably a pediatrician, if their child complains of earache or ear pressure that lasts longer than a day or that is accompanied by fever. A child who discharges blood or pus from the ear requires prompt medical attention. Such symptoms often indicate that the eardrum has been punctured.

Diagnosis begins with a physical examination and thorough medical history. The physician often uses an instrument called an otoscope to search for signs of eustachian tube blockage, such as air bubbles or fluid behind the eardrum. Children who have otitis media with effusion (in which fluid builds up in the ear) may not have noticeable symptoms, and the condition may be diagnosed during the regular well-child visits.

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 such as redness of the eardrum or a bulging of the eardrum may also 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. Ear infections suspected from an examination using an otoscope may be confirmed with a tympanometry.

The physician may also look for signs of strep throat or the presence of tonsillitis.

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 should at least be considered. If hearing loss is detected in both ears, antibiotic therapy is recommended.