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Otitis Media (Chronic)

By Richard T. Miyamoto, MD, MS, Arilla Spence DeVault Professor Emeritus and Past-Chairman, Department of Otolarynology - Head and Neck Surgery, Indiana University School of Medicine

Chronic otitis media is a long-standing, persistently draining perforation of the eardrum.

  • Acute otitis media and blockage of a eustachian tube are among the causes of chronic otitis media.

  • A flare-up may occur after a cold, an ear infection, or after water enters the middle ear.

  • People usually have hearing loss and persistent drainage from the ear.

  • Doctors clean the ear canal and give ear drops.

  • Antibiotics and surgery may be used for severe cases.

Chronic otitis media is usually caused by acute otitis media, blockage of the eustachian tube (which connects the middle ear and the back of the nose), an injury to the ear, or blast injuries.

Chronic otitis media may flare up after an infection of the nose and throat, such as the common cold, or after water enters the middle ear through a hole (perforation) in the eardrum while bathing or swimming. Usually, flare-ups result in a painless discharge of pus, which may have a very foul smell, from the ear. Persistent flare-ups may result in the formation of protruding growths called polyps, which extend from the middle ear through the perforation and into the ear canal. Persistent infection can destroy parts of the ossicles—the small bones in the middle ear that connect the eardrum to the inner ear and conduct sounds from the outer ear to the inner ear—causing conductive hearing loss (hearing loss that occurs when sound is blocked from reaching the sensory structures in the inner ear).

Some people with chronic otitis media develop a cholesteatoma in the middle ear. A cholesteatoma is a noncancerous (benign) growth of white skinlike material. A cholesteatoma, which destroys bone, greatly increases the likelihood of other serious complications such as inflammation of the inner ear, facial paralysis, and brain infections.


  • A doctor's evaluation

A doctor diagnoses chronic otitis media when pus or skinlike material accumulates in a hole or in a pocket in the eardrum that often drains. To identify the bacteria causing the infection, doctors take samples of the discharge from the ear.

If doctors suspect the person has a cholesteatoma, they may do computed tomography (CT) or magnetic resonance imaging (MRI) tests.


  • Antibiotic ear drops

  • Sometimes antibiotics by mouth

When chronic otitis media flares up, doctors prescribe antibiotic ear drops. People with severe flare-ups are also given antibiotics by mouth. Water must be kept out of the ear when a perforation is present.

Usually, the eardrum perforation can be repaired by a procedure called tympanoplasty. If the ossicles have been damaged, they may be repaired at the same time. A cholesteatoma must be removed surgically. Otherwise, serious complications can develop.