Diagnosis of Ear Infections
The diagnosis of ear infections is typically straightforward and begins with a physical examination by a general practitioner or paediatrician. In many cases, ear infections are diagnosed based on symptoms and a look inside the ear using a special instrument called an otoscope. This allows the doctor to check for signs of inflammation, fluid behind the eardrum, or visible damage to the ear canal or eardrum.
In middle ear infections (otitis media), the eardrum may appear red, swollen, or bulging. Sometimes, fluid or pus may be visible behind the membrane. If the eardrum has ruptured, the doctor may see a hole or fluid leaking out. This is often accompanied by a sudden relief in pain followed by discharge.
Outer Ear Infections
For outer ear infections (otitis externa), the ear canal may appear red, swollen, and tender to touch. There may be discharge, and the patient often reports pain when the outer ear is moved. If a fungal infection is suspected, swabs may be taken for analysis.
In cases of suspected inner ear infections, additional testing may be necessary. Balance problems, dizziness, or hearing loss suggest deeper involvement. Audiometry tests can assess hearing function, while more advanced tools like tympanometry may measure eardrum movement and detect fluid buildup. In rare cases, imaging such as CT or MRI may be used to rule out more serious issues like abscesses or mastoiditis.
In South Africa, the diagnosis of ear infections is sometimes made at community clinics or by nurses, especially in rural areas. Otoscopes may not always be available, so diagnosis often relies on symptoms alone. While this is usually sufficient for treatment, there is a risk of misdiagnosis or under-diagnosis when equipment or training is lacking.
Hearing tests are particularly important in children with recurrent ear infections. Persistent fluid in the middle ear can cause temporary hearing loss, which in turn can affect speech and learning. If concerns arise, a referral to an audiologist or ENT (ear, nose and throat) specialist is recommended.
Diagnosis of Ear Infections
For babies and toddlers, doctors may also assess behaviour and responsiveness to sound. A child who does not respond to voices, loud noises, or turns up the TV volume excessively may be suffering from temporary hearing issues due to unresolved ear infections.
Accurate diagnosis of ear infections ensures that treatment is appropriate and effective. Overuse of antibiotics can lead to resistance, so identifying whether an infection is viral or bacterial is key. In many cases, especially with mild symptoms, a “watchful waiting” approach may be used for 48 hours before starting antibiotics.
Timely diagnosis helps prevent complications, especially in children. It also gives parents and caregivers the information needed to monitor progress and seek follow-up care if symptoms persist or worsen.
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