You Can Diagnose Your Child’s Ear Infection—Here’s How

All you need to diagnose your child’s ear infection is some basic knowledge and some basic inexpensive medical instruments which you can get online. In this post, I’ll go over both topics.

Doctors require three elements to make a diagnosis of acute otitis media.

The first is an acute (meaning relatively sudden) start of a symptom or symptoms of ear infection which can be ear pain severe enough to keep the child from sleeping or from regular activity. It can also be fever. It can be irritability in an infant. And it can be fluid draining out of the ear.

So the first thing you do is ask  if any of those symptoms are present. If yes, you’ve met the first requirement for diagnosis.

The second requirement is presence of fluid behind the eardrum which is called middle ear effusion. Normally, the space behind the ear drum has only air in it.

Doctors do this by what is called pneumatic otoscopy. They look through the otoscope at the eardrum while they blow air at the eardrum. If there is fluid in behind the eardrum the eardrum won’t move normally. This test is subjective and a more accurate test doctors use is tympanometry but this instrument is too expensive for home use.

The third requirement is redness of the eardrum, bulging of the eardrum, or opacity of the eardrum (normally you can see the bones of the middle ear through the eardrum).

To look at the eardrum you need a home otoscope. These are also available online or at your drugstore. They are not too expensive.

Here is how you examine your child’s eardrum with the otoscope:

First, gently pull on the ear lobe and then on the outer ear. If this causes pain, stop. The child may have an external otitis. External otitis is an infection of the skin of the ear canal (sometimes called swimmer’s ear).

Next, have child sit on one of the parent’s lap so he can see the parent’s face. Sitting is better than lying down because you are more likely to see fluid behind the eardrum if the child is sitting. Say, “I’m going to check daddy’s ear first to see if he is okay. Place the otoscope in the parent’s ear so that the child can see that it doesn’t hurt.

Then examine the child’s ear. Have the child lean against the parent’s chest sitting up. Hold the otoscope as I do in the picture, with the little finger braced against the child’s cheek. This way if the child moves suddenly you won’t hurt him as the otoscope will move rather than go to deep into ear canal.

Picture of Doctor holding the otoscope correctly

If only one ear hurts, examine the one that doesn’t hurt first.

To straighten out the ear canal to make eardrum easier to see, pull the outer ear gently up and back with your free hand for children older than twelve months.

For infants you will gently pull the outer ear down and back.

Put the tip of scope just at the opening and look for the eardrum—you don’t need to go into ear canal very far at all to see eardrum.

First look at the ear canal leading up to the eardrum. The ear canal should be the color of normal skin. If it is swollen and red or filled with pus, the child may have an external ear infection (external otitis media—swimmer’s ear) that is treated with prescription ear drops.

Then look at the eardrum. Normally it is a light grey color or a whitish pearly color. You will see a light reflection normally. You’ll be able to see through the normal ear drum and to see little bones of the middle ear.

An abnormal eardrum may be red and bulging or you may be able to actually see fluid and bubbles behind the eardrum.

You may see a hole in the eardrum (a perforation) if there is drainage from the ear canal.

So if you have the three elements all present (sudden onset of symptoms, fluid behind the eardrum as indicated by the EarCheck, and an abnormal eardrum [red, bulging, or fluid or bubbles seen behind it], you can confidently diagnose acute otitis media.

Sometimes one (or occasionally,two) of the elements may be absent but the child could still have an acute otitis media requiring treatment.

In another post, I’ll go over how to treat acute otitis media.

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Reference: Clinical Practice Guideline—Diagnosis and Management of Acute Otitis Media available at

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