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PRIMARY CARE SERVICES

Diagnosis & Treatment

Ear Infection (Otitis)

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How is an Ear Infection Diagnosed?

Diagnosis

Most ear infections can be diagnosed in your doctor's office. The doctor will ask about symptoms and perform an exam using a pneumatic otoscope tool during an ear infection diagnosis. The doctor can see inside the ear with the otoscope and gently puff air against the eardrum. A normal eardrum will move when the air is applied, but there will be little to no movement if fluid and infection are present. There may also be redness in the area.

If you have persistent ear infections or complications, your doctor may use these tests to determine if your symptoms may be caused by something else:

  • Tympanometry to examine movement of the eardrum and assess pressure in the middle ear
  • Acoustic reflectometry to measure fluids in the middle ear
  • Tympanocentesis to pierce the eardrum using a tiny tube and gather a sample of fluid to analyze for bacteria or viruses if the ear infection has not been responding to treatment
  • Audiology (hearing test)

People with labyrinthitis or vestibular neuritis symptoms may undergo:

  • MRI to rule out other causes of dizziness (such as a stroke)
  • Electrocardiogram to see if symptoms are due to a heart problem
  • Vestibular tests to assess the function of the vestibulocochlear nerve, using electrodes to check eye movements and determine the cause of symptoms

How can a primary care doctor help?

Your pediatrician or primary care doctor can assess symptoms and make an ear infection diagnosis, as well as prescribe treatment. If ear infections persist or complications develop, you may be referred to an ear, nose, and throat (ENT) physician, who has special training in the care of ear infections and related disorders.

People with vestibular neuritis may be referred to a neurotologist (a doctor with expertise in the nervous system as it relates to the ear). Those with impaired hearing may see an audiologist for a hearing test.

How Are Ear Infections Treated?

Treatment

Most bacterial ear infections are treatable using antibiotics. Your doctor may wait a few days to see if it can get better on its own before prescribing medicine for an ear infection ("watchful waiting") or give you a prescription but suggest you wait 2 to 3 days before taking it to see if you feel better without it ("delayed prescribing"). Your doctor may initiate treatment for your ear infection with antibiotics based on your symptoms.

Nonsurgical treatments

In addition to antibiotics, other ear infection treatments that may help relieve symptoms include:

  • A warm compress on the ear
  • Acetaminophen to reduce pain
  • Anesthetic ear drops to relieve discomfort
  • Ear drops for swimmer's ear
  • Vestibular therapy for labyrinthitis and vestibular neuritis—rehabilitation exercises that retrain the brain to adapt to changes in balance
  • Motion sickness pills (such as diphenhydramine, dimenhydrinate, and meclizine) to help reduce dizziness and vertigo

Ear tube surgery

Some people with chronic and recurrent ear infections benefit from an outpatient surgery called myringotomy to treat their ear infection. The surgeon makes a tiny hole in the eardrum and suctions fluid from the middle ear. A tiny tympanostomy tube is placed into the opening to promote drainage and prevent fluids from building up in the middle ear. Some patients also have enlarged adenoids removed during the same procedure.

Most tubes stay in place for up to 18 months and then fall out independently. Sometimes the procedure must be repeated in a child with recurring ear infections after the first set of tubes falls out. Eventually, the tubes are no longer needed and the hole in the eardrum closes on its own.

FAQs

FAQs

Ear infections often go away on their own. If they persist after a few days, antibiotics may be prescribed to treat the infection. Some people need a tiny tube surgically inserted in the eardrum for chronic ear infections to promote drainage and prevent fluid build-up in the middle ear. Vestibular therapy may help people with dizziness and vertigo from inner ear infections.

When a doctor looks into the ear with an otoscope and applies a small puff of air, the eardrum will not move much or at all if there is fluid behind it from a middle ear infection. There may also be redness in the area.

Ear infections happen when the eustachian tube (which connects the middle ear to the throat) gets blocked and fluid builds up. Bacteria or viruses can cause an infection that spreads up the tube into the middle ear. Ear infections may be triggered by a cold, flu, allergies, drinking milk while lying down, exposure to tobacco smoke, and other factors.

An ear infection can cause ear pain, headache, a feeling of a clogged ear, fever, dizziness, or loss of balance.

If you have symptoms of an ear infection, a visit to your primary care doctor can help determine if they are due to an ear infection. Your doctor will assess your symptoms and look into your ears with an otoscope to make the diagnosis.
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Trust NewYork-Presbyterian for Ear Infection Treatment

If you or your child has symptoms that suggest there may be an ear infection, contact NewYork-Presbyterian for an in-person visit to one of our campuses or medical groups or to schedule a telehealth appointment.

We offer convenient hours and scheduling, connection with our providers through a patient portal, and referrals to specialists. We also take most insurance plans.