To diagnose an ear infection, you have to look at the eardrum

The Pediatric Insider

© 2012 Roy Benaroch, MD

“I can just tell he has an ear infection! Can’t you just call in an antibiotic?”

I don’t want kids to suffer, and I don’t want kids having to go to an ER or busy after-hours place on the weekend. (In Atlanta, parents have a great after-hours alternative—kids can see a real pediatrician after hours!) Why not just call in weekend antibiotics without seeing the child? If a parent thinks their toddler has an ear infection, how likely is it that they’re right?

Researchers in Finland tried to find out. In a 2010 study, they reported their findings based on 469 children over a 2 year period who were brought to a clinic because of parental concerns of a possible ear infection. The children were all aged 6 – 35 months. Prior to their exams, parents recorded the degree of ear pain, irritability, crying, restless sleep, fevers, and many other symptoms. Examinations were performed with state-of-the-art equipment, and videos of the ear exams were reviewed by an ENT specialist to confirm the diagnoses.

It turned out that none of the symptoms could reliably differentiate children with ear infections from children whose ears were normal. Not pain, not height of fever, not how the children were acting. Parents who reported these symptoms were just as likely to have  a child with or without a real ear infection. Ear rubbing was actually more common in kids who did not have an ear infection.

The only reliable way to tell if a child has an ear infection is to look at the eardrum. Even then, it’s not always easy. Sometimes there’s wax, and sometimes, even for me, children squirm and yell. Unless you get a good exam, there is just no way to know. And it is important to know, before you start antibiotics– if you’re going to use antibiotics at all. Since many ear infections will improve without antibiotics, unless a child seems really miserable it’s often best to wait a few days, especially if it’s a weekend. An ear infection that got better on its own didn’t need to see the doctor, anyway!

So: if your child seems to have an ear infection on the weekend, do things to help him feel better. A gentle heating pad or a dose of ibuprofen or acetaminophen will provide quick relief. Emergency, weekend care is really only needed if your child remains miserable even after pain medication. Starting antibiotics without a sure diagnosis is like flipping a coin—you may be doing more harm than good.

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One Comment on “To diagnose an ear infection, you have to look at the eardrum”


  1. As a pediatrician I agree that the only way to tell is by looking. When I was out of town one weekend, my wife called Sunday morning to have an antibiotic phoned to the pharmacy because our 4 year old woke up complaining of ear pain. She was mad at me when I told her to go see the pediatrician working our after hours clinic to see if in fact it was infected. She called me an hour later to admit I was right to not phone in an antibiotic. Turns out it was impacted ear wax and he was better after he got his ear cleaned.

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