A health care professional usually diagnoses the cause of an earache by talking to the patient, parent, or caregiver (taking history) and performing a physical examination. In general, X-rays and other tests are unnecessary.
The health care professional often uses an otoscope to look into the ear canal to evaluate the canal and the ear drum.
- If otitis externa is the cause of the earache, the ear canal will look swollen and inflamed. There may be thick drainage visible. Sometimes, the canal may be so swollen and painful that the diagnosis is made because of the difficulty with inserting the plastic end of the scope into the canal.
- Bullous myringitis is diagnosed by using the otoscope to visualize the ear drum. The tissue will look inflamed and fluid blisters can be seen.
- Otitis media causes inflammation and swelling of the middle ear. The health care practitioner cannot see the middle ear directly but instead, uses the otoscope to look at the ear drum. Initially, fluid fills the middle ear (serous otitis media), and there may be air and fluid bubbles seen behind the drum. As pressure builds, the ear drum may not move if a small puff of air is pushed through the otoscope. If the eardrum looks red and inflamed, the diagnosis of acute otitis media is made. The presence of fluid is called an effusion and may persist for two to three months after the acute infection has resolved.
The health care professional also may evaluate other parts of the body including the throat (looking for sore throat or tonsillitis), the neck (feeling for swollen lymph nodes and assessing stiffness), and the lungs (looking for signs of pneumonia). This is especially important if the earache persists and there is no apparent reason for ear pain on examination. Referral to an ear, nose, and throat specialist may be necessary to evaluate the structures deeper in the thraot with an endoscope (flexible camera) or a mirror.
- Hearing tests may be recommended if there have been recurrent infections or if there has been a delay in speech development.
- Laboratory testing is usually not indicated in caring for routine ear infections.
- Rarely, a sample of drainage from the ear is sent to the laboratory in an attempt to identify the specific bacteria causing the infection. Sending the sample to the laboratory is not necessary in most cases and usually is reserved for infections that do not respond to normal treatment.
Medically Reviewed by a Doctor on 3/23/2015
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