Chronic middle ear infections can be caused by acute middle ear infections, blockage of the eustachian tube, injuries, burns, or placement of tubes through the eardrum.
Children usually have hearing loss and ear discharge.
A doctor diagnoses chronic middle ear infection based on examination findings.
Treatment usually includes antibiotic drops and sometimes antibiotics taken by mouth, insertion of ear tubes, or both.
(See also Overview of Middle Ear Infections in Young Children Overview of Middle Ear Infections in Young Children Middle ear infection is infection of the space immediately behind the eardrum. Middle ear infections (otitis media) may occur in older children and adults (see Otitis Media (Acute)) but are... read more and Otitis Media (Chronic) Otitis Media (Chronic Suppurative) Chronic suppurative otitis media is a long-standing, persistently draining perforation of the eardrum (tympanic membrane). Acute otitis media and blockage of a eustachian tube are among the... read more in adults.)
Chronic middle ear infections can be caused by an acute middle ear infection Acute Middle Ear Infection in Children Acute middle ear infection is a bacterial or viral infection of the middle ear, usually accompanying a cold. Bacteria and viruses can infect the middle ear. Children with ear infections may... read more (usually several), blockage of the eustachian tube (the tube that connects the middle ear Middle Ear The ear, which is the organ of hearing and balance, consists of the outer, middle, and inner ear. The outer, middle, and inner ear function together to convert sound waves into nerve impulses... read more with the nasal passages Nose and Sinuses The nose is the organ of smell and a main passageway for air into and out of the lungs. The nose warms, moistens, and cleans air before it enters the lungs. The bones of the face around the... read more ), crushing or penetrating injuries to the ear, thermal or chemical burns, or blast injuries. Additionally, children who have head and face abnormalities resulting from chromosomal disorders, such as Down syndrome Down Syndrome (Trisomy 21) Down syndrome is a chromosome disorder caused by an extra chromosome 21 that results in intellectual disability and physical abnormalities. Down syndrome is caused by an extra chromosome 21... read more or cri du chat syndrome Cri-du-Chat Syndrome Cri-du-chat syndrome is a chromosomal deletion syndrome in which part of chromosome 5 is missing. (See also Overview of Chromosome Disorders.) Cri-du-chat syndrome is a rare syndrome in which... read more , or who have a cleft palate Cleft Lip and Cleft Palate The most common birth defects of the skull and face are cleft lip and cleft palate, affecting about 2 of every 1,000 babies. Cleft lip is a separation of the upper lip, usually just below the... read more have an increased risk of chronic middle ear infections.
Chronic middle ear infections may flare up after an infection of the nose and throat, such as the common cold Common Cold The common cold is a viral infection of the lining of the nose, sinuses, and throat. Many different viruses cause colds. Usually, colds are spread when a person's hands come in contact with... read more , or after water enters the middle ear while bathing or swimming in children who have a perforated eardrum or tubes. Usually, flare-ups result in a painless discharge of pus from the ear (see Ear Discharge Ear Discharge Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus (purulent). Depending on the cause of the discharge, people may also have... read more ). The pus may have a very foul smell.
Persistent flare-ups may cause
Polyps are noncancerous (benign), smooth growths that protrude from the middle ear through the perforation and into the ear canal.
Persistent infection can destroy parts of 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 (the ossicles), causing hearing loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 10% of people in the United States have some degree of hearing loss that affects their... read more .
A cholesteatoma is a noncancerous (benign) growth of white skinlike material in the middle ear. A cholesteatoma can destroy nearby bone and soft tissue and can eventually cause complications such as facial paralysis and abscesses in the brain or between the brain and the skull.
A doctor diagnoses chronic middle ear infection based on examination findings (for example, when pus drains out of a hole in the eardrum or skinlike material accumulates in the hole or in a pocket in the eardrum). Samples of the pus are sent to a laboratory where bacteria can be grown (cultured Culture of Microorganisms Infectious diseases are caused by microorganisms, such as bacteria, viruses, fungi, and parasites. Doctors suspect an infection based on the person's symptoms, physical examination results,... read more ).
If a doctor suspects a cholesteatoma or a complication, imaging studies such as computed tomography Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more (CT) or magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI) are done.
Doctors first clean any debris from the ear. At home, parents apply ear drops containing an antibiotic and possibly a corticosteroid. Children who have a severe infection are given antibiotics taken by mouth.
If infection lasts or comes back despite the use of antibiotics, doctors may, after a period of time, do a myringotomy with insertion of ventilating (tympanostomy) tubes. If the eardrum is damaged, surgery to repair the eardrum (tympanoplasty) may be done.
A cholesteatoma is removed surgically.