Chronic Otitis Media

Chronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back. It causes long-term or permanent damage to the ear.

Causes
The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid made in the middle ear. If the Eustachian tube becomes blocked, fluid can build up. When this happens, infection can occur. A chronic ear infection develops when fluid or an infection behind the eardrum does not go away.

A chronic ear infection may be caused by:

  • An acute ear infection that does not completely go away
  • Repeated ear infections

"Suppurative chronic otitis" is a phrase health care providers use to describe an eardrum that keeps rupturing, draining, or swelling in the middle ear or mastoid area and does not go away.

Ear infections are more common in children because their Eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much less common than acute ear infections.

Symptoms
Symptoms of a chronic ear infection may be less severe than symptoms of an acute infection. The problem may go unnoticed and untreated for a long time.

Symptoms may include:

  • Ear pain or discomfort that is usually mild and feels like pressure in the ear
  • Fever, usually low-grade
  • Fussiness in infants
  • Pus-like drainage from the ear
  • Hearing loss

Symptoms may continue or come and go. They may occur in one or both ears.
Exams and Tests
The health care provider will examine the ears. This may reveal:

  • Dullness, redness in the middle ear
  • Air bubbles in the middle ear
  • Thick fluid in the middle ear
  • Eardrum that sticks to the bones in the middle ear
  • Draining fluid from the eardrum
  • A hole (perforation) in the eardrum
  • An eardrum that bulges out or pulls back inward (collapses) 

Tests may include:

  • Cultures of the fluid may show bacteria, and these bacteria may be harder to treat than the bacteria commonly involved in an acute ear infection.
  • A CT scan of the head or mastoids may show that the infection has spread beyond the middle ear.
  • Hearing tests may be needed. 

Treatment
The provider may prescribe antibiotics if the infection is caused by bacteria. These medicines may need to be taken for a long time. They can be given by mouth or into a vein (intravenously).

If there is a hole in the eardrum, antibiotic ear drops are used. The provider may recommend using a mild acidic solution (such as vinegar and water) for a hard-to-treat infected ear that has a hole (perforation). A surgeon may need to clean out (debride) tissue that has gathered inside the ear.

Other surgeries that may be needed include:

  • Surgery to clean the infection out of the mastoid bone (mastoidectomy)
  • Surgery to repair or replace the small bones in the middle ear
  • Repair of the eardrum
  • Ear tube surgery

Outlook (Prognosis)
Chronic ear infections most often respond to treatment. However, your child may need to keep taking medicines for several months.

Chronic ear infections are not life threatening. However, they can be uncomfortable and may result in hearing loss and other serious complications.

 

 

Source: NIH   MedlinePlus