Otitis media - chronic
Definition
Chronic otitis media is inflammation or infection of the middle ear that persists or keeps coming back.
See also: Acute otitis media
Alternative Names
Middle ear infection - chronic; Ear infection - chronic; Chronic otitis media; Chronic ear infection
Causes
Chronic otitis media is present when fluid behind the eardrum does not go away. It occurs when the Eustachian tube becomes blocked repeatedly (or remains blocked for long periods) due to allergies, multiple infections, ear trauma, or swelling of the adenoids. The Eustachian tube is the passage from the back of the nose to the middle ear.
When the middle ear is actually infected with bacteria (or occasionally, viruses) rather than just inflamed, it is more serious. A chronic ear infection may be the result of an acute ear infection that does not clear completely, or the result of recurrent ear infections. The infection may spread into the mastoid bone behind the ear (mastoiditis), or fluid build-up may cause pressure that ruptures the eardrum or damage the bones of the middle ear.
"Suppurative chronic otitis" is a phrase doctors use to describe an eardrum that keeps rupturing or draining or inflammation in the middle ear or mastoid area that does not go away.
A chronic ear infection may be more destructive than an acute ear infection because its effects are prolonged or repeated, and it may cause permanent damage to the ear. However, a chronic, long-term infection may show less severe symptoms -- so the infection may remain unnoticed and untreated for a long time.
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
Note: Symptoms may be continuous or intermittent, and may occur in one or both ears.
Exams and Tests
An examination of the ear may show dullness, redness, air bubbles, or fluid behind the eardrum. The eardrum may show drainage or perforation (a hole in the eardrum). The eardrum may bulge out or retract inward.
Cultures of drainage may show bacteria. These bacteria may be resistant or harder to treat than the bacteria commonly involved in acute ear infection.
Skull x-rays or a CT scan of the head or mastoids may show spreading of the infection beyond the middle ear.
Hearing tests may be needed.
Treatment
Antibiotics may be prescribed if the doctor thinks the infection is due to bacteria. Antiobiotics may need to be taken for a long time, either by mouth or in the form of antibiotic ear drops if there is a hole in the eardrum.
Surgery to remove the adenoids may be needed to allow the eustachian tube to work properly. The surgeon may make an opening in the eardrum to allow fluid to drain. This is called a myringotomy. The procedure may or may not involve placing tubes in the ear.
Surgery to repair a ruptured eardrum may prevent further chronic ear infections.
Keep the ears clean and dry to prevent reinfection. This is particularly important if myringotomy has been performed.
Outlook (Prognosis)
Chronic otitis media usually responds to treatment, but your child may need to continue taking medicines for several months. Such ear infections are not life threatening but can be uncomfortable and may result in hearing loss and other serious complications.
Possible Complications
- Cyst of the middle ear cyst (cholesteatoma)
- Facial paralysis
- Infection of one of the skull bones (mastoiditis)
- Inflammation around the brain (epidural abscess)
- Permanent damage to the ear with partial or complete deafness
Most children will have temporary and minor hearing loss during and right after an ear infection, because fluid can linger in the ear. Although this fluid can go unnoticed, it can cause significant hearing problems in children. Any fluid in the ear that lasts longer than 8-12 weeks is cause for concern. In children, hearing problems may cause speech to develop slowly.
Permanent hearing loss is rare, but the risk increases with the number and length of infections.
When to Contact a Medical Professional
Call for an appointment with your health care provider if you or your child has signs of chronic otitis media, including an episode of acute otitis media that does not respond to treatment.
Call your health care provider if chronic otitis media does not respond to treatment, or if new symptoms develop during or after treatment.
Prevention
Prompt treatment of acute ear infections may reduce the risk of development of chronic otitis media. Follow-up examination after treatment of an ear infection will ensure that it is completely cured.
Review Date:
4/22/2008
Reviewed By:
Alan Lipkin, MD, Otolaryngologist, Private Practice, Denver, Colorado. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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