The doctor should be sure to ask the parent if the child has had a recent cold, flu, or other respiratory infection. If the child complains of pain or has other symptoms of otitis media, such as redness and inflammation, the doctor should rule out any other causes. These may include:
- Otitis media with effusion. OME is commonly confused with acute otitis media. OME must be ruled out because it does not respond to antibiotics.
- Dental problems (such as teething).
- Infection in the outer ear. Symptoms include pain, redness, itching, and discharge. Infection in the outer ear, however, can be confirmed by tugging the outer ear, which will produce pain. (This movement will have no significant effect if the infection is in the middle ear.)
- Foreign objects in the ear. This can be dangerous. A doctor should always check for this first when a small child indicates pain or problems in the ear.
- Viral infection can produce redness and inflammation. Such infections, however, are not treatable with antibiotics and resolve on their own.
- A parent's or child's attempts to remove earwax.
- Intense crying can cause redness and inflammation in the ear.
Instruments Used for Examining the Ear. An ear examination should be part of any routine physical examination in children, particularly because the problem is so common and may not cause symptoms.
- The doctor first removes any ear wax (called cerumen) in order to get a clear view of the middle ear.
- The doctor uses a small flashlight-like instrument called an otoscope to view the ear directly. This is the most important diagnostic step. The otoscope can reveal signs of acute otitis media, bulging eardrum, and blisters.
Review Date: 05/03/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.