Middle Ear Evaluations

Doctor auscultating the ear of a child in examination room

What is a Middle Ear Evaluation?

Your middle ear is located on the other side of your ear drum and is the part of your ear that is most prone to ear infections, which often start in the Eustachian tubes. If your doctor suspects that you or your child have an ear infection, he or she will use an otoscope to examine the ear. They will be looking for signs of inflammation, swelling and redness on or near the eardrum. Your doctor will perform a middle ear evaluation to determine if your hearing problem is conductive or nerve related (sensorineural). It will also help your doctor assess any balance problems that you may be having.

Pneumatic Otoscope

To examine your middle ear, your doctor may use a pneumatic otoscope to check the pressure on the eardrum caused by the mucous or fluid that has collected in the middle ear. The device injects a small amount of air onto the eardrum and then measures the rate of movement of the eardrum. If the eardrum does not move readily, it can indicate that fluid caused by an infection is present in the mid-ear area.

Tympanometry and Acoustic Reflex Testing

For an even more detailed analysis, your doctor may use tympanometry to detect fluid in the middle ear and possible infection, to identify a perforation of the eardrum and to identify Eustachian tube problems. This process is also called acoustic immittance testing. The tests are quite easy to take, lasting just a few minutes each. You will feel pressure against your ear drum and you may hear a tone. These tests also measure your acoustic reflex, which is a self-protective reflex of your auditory system.

Vestibular Tests

An important survival function is your sense of balance, which is located in your middle ear and controlled by your vestibular system. The vestibular system is composed of tiny, semi-circular canals in the upper part of your inner ear. Without this system, you could not stand up, walk and run so they are very important to your survival. These small canals provide your brain with information such as your angular and linear acceleration, which allow you to navigate the world without falling flat on your face.
To test your sense of balance, you may be given Vestibular Tests which are also called ‘falling and past pointing’ tests. These test are important to determine if your balance system is functioning. During these tests you will be asked to stand and hold your arms in certain positions, stand toe to heel, stand on one foot and follow the directions of the technician, sometimes with your eyes closed so that your ENT & AA team can fully analyze your sense of balance.

Who should have a Middle Ear Evaluation?

It is important to have a Middle Ear Evaluation if you or your child is presenting these symptoms that may relate to ear infections:

  • Ear pain (a child may pull on an ear)
  • Increased crying (children)
  • Poor sleep
Decreased eating
Hearing loss

Discharge from ear

If you or your child are suffering from a perforated or burst ear drum, you may need to have an inner ear evaluation if you have these symptoms:

  • Ear pain similar to an ear infection
  • Pain from an injury from athletic event such as boxing, wrestling, soccer, football, scuba diving, water skiing
  • Pain caused by an acoustic trauma from a loud noise
  • Hearing loss
  • Tinnitus

Medical Evaluation

Your ENT & AA clinician will assess the test results and provide you with a personalized strategy to treat your ear problem and help you return to your happy, healthy self.