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Chronic Middle Ear Infection in Children

(Chronic Otitis Media)

By Udayan K. Shah, MD, Pediatric Otolaryngologist ;Pediatric Otolaryngologist , Nemours/Alfred I duPont Hospital for Children;Thomas Jefferson University

Chronic middle ear infection results from recurring infections that damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection.

  • 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 repeated ear irrigation and antibiotic ear drops.


Chronic middle ear infections can be caused by acute middle ear infection (see Acute Middle Ear Infection in Children), blockage of the eustachian tube, 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 (see Down Syndrome (Trisomy 21)) or cri du chat syndrome (see Cri du chat syndrome (cat’s cry syndrome)), or who have a cleft palate (see Facial Defects) 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, or after water enters the middle ear while bathing or swimming in children who have a perforated eardrum. Usually, flare-ups result in a painless discharge of pus from the ear. The pus may have a very foul smell.


Persistent flare-ups may cause

  • Polyps of the middle ear

  • Destruction of bones in the middle ear

  • Cholesteatoma

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 (see Causes).

A cholesteatoma is a noncancerous 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.


Children usually have hearing loss and ear discharge. There is usually no pain unless a complication has occurred. Children who have a cholesteatoma may also have white debris in the ear canal.


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). If a doctor suspects a cholesteatoma or a complication, imaging studies such as computed tomography (CT—see Computed Tomography (CT)) or magnetic resonance imaging (MRI—see Magnetic Resonance Imaging (MRI)) are done.


Doctors may first clean all the debris from the ear. Parents irrigate the child's ear using a bulb syringe and a solution of sterile water and vinegar 3 times daily. Parents also apply ear drops containing a corticosteroid and an antibiotic twice daily for 14 days. Children who have a severe infection are given antibiotics taken by mouth for 10 days. If infection persists or recurs despite the use of antibiotics, doctors may, after a period of time, do a myringotomy with insertion of ventilating (tympanostomy) tubes (see Myringotomy: Treating Recurring Ear Infections). If the eardrum is damaged, surgery to repair the eardrum (tympanoplasty) may be done. A cholesteatoma is removed surgically.

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