Diagnosing Ear Infections Not Always Easy
Sue Hubbard, M.D.
One of the most frequent reasons for a visit to the pediatrician continues to be ear infections (otitis). Especially at this time of year, when we're still in the throes of "cough and cold" season, the otoscope (device used to look into the ear), is getting worn out!
Over the years, thousands of articles have been published on the diagnosis and treatment of ear infections. Parents continue to ask, "How do I know if my child has an ear infection?" and the answer has yet to change. The only way to diagnose otitis is by looking at the eardrum.
There's not a symptom or combination of symptoms that will lead to the diagnosis of ear infection without looking at the eardrum. So, babies who pull on their ears, or awaken at night, children with a fever and cough, or even those who say their ears hurt, don't always have an ear infection.
There are many days that a 2- to 4-year-old child will say, "my ear hurts" and the patient is whisked into my office. When I check the eardrum, it looks perfectly normal. The pain may be due to pressure behind the eardrum, or referred pain from a sore throat or tooth, or even just a passing feeling in the ear after putting the child put a finger in their ear canal. You have to look, and therefore the diagnosis may not be made over the phone (maybe one day there will be an App for visualizing the eardrum remotely).
When a doctor looks down your child's ear canal, they're looking for an eardrum that's either bulging or red (if the child is not crying or doesn't have high fever, as this may cause redness of the eardrum), or for fluid behind the eardrum (called an effusion).
In most cases, a combination of findings tells the tale. For a practicing pediatrician, visualizing an eardrum in a squirming, screaming toddler with waxy ears, is an art. Yes, ears can be full of wax and you won't even realize it. (Don't use a Q-tip, which just makes things worse!)
Cleaning out a child's ear is necessary and not always fun for patient or doctor. One of the hardest skills to learn in early pediatric training is how to look at an eardrum. I remember needing months of practice and instruction before believing I was getting better with an otoscope.
Many parents ask if they can look in their child's ears at home with an otoscope that they bought on line.
"Sure," I reply, "if you want to spend a year in the ER looking in thousands of ears!" Just like I'm sure I could learn how to "tune up my car" if I worked in a garage for months, or tried to learn to speak a language by immersion, mastering the use of an otoscope is based upon repetition and practice. Parents have told me there are even some "swanky" otoscopes that purportedly talk to you and tell you if the ear is infected, but none of these devices are accurate. You have to rely on the old-fashioned otoscope and know what you're looking for.
So, ear pain and ear infections are not synonymous and the "gold standard" of visualizing the eardrum is the only accurate way to diagnose an ear infection.
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