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Ear infection - chronic
Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection
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. It most often involves a hole in the eardrum that does not heal.
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
Acute ear infection
Ear infections are one of the most common reasons parents take their children to the doctor. The most common type of ear infection is called otitis ...
ImageRead Article Now Book Mark Article - 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
Drainage from the ear
Ear discharge is drainage of blood, ear wax, pus, or fluid from the ear.
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Hearing loss
Hearing loss
Hearing loss is being partly or totally unable to hear sound in one or both ears.
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Symptoms may continue or come and go. They may occur in one or both ears.
Exams and Tests
The 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.
CT scan of the head
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
ImageRead Article Now Book Mark Article - 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
)
Mastoidectomy
A mastoidectomy is surgery to remove cells in the hollow, air-filled spaces in the skull behind the ear. These cells are called mastoid air cells....
ImageRead Article Now Book Mark Article - Surgery to repair or replace the small bones in the middle ear
- Repair of the eardrum
-
Ear tube surgery
Ear tube surgery
Ear tube insertion involves placing tubes through the eardrums. The eardrum is the thin layer of tissue that separates the outer and middle ear. ...
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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.
Possible Complications
A chronic ear infection may cause permanent changes to the ear and nearby bones, including:
-
Infection of the mastoid bone behind the ear (
mastoiditis
)
Mastoiditis
Mastoiditis is an infection of the mastoid bone of the skull. The mastoid is located just behind the ear.
ImageRead Article Now Book Mark Article - Ongoing drainage from a hole in the eardrum that does not heal, or after the ear tubes are inserted
-
Cyst in the middle ear (
cholesteatoma
)
Cholesteatoma
Cholesteatoma is a type of skin cyst that is located in the middle ear and mastoid bone in the skull.
ImageRead Article Now Book Mark Article - Hardening of the tissue in the middle ear (tympanosclerosis)
- Damage to, or wearing away of the bones of the middle ear, which help with hearing
-
Paralysis of the face
Paralysis of the face
Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one side of the face.
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Inflammation around the brain (
epidural abscess
) or in the brain
Epidural abscess
An epidural abscess is a collection of pus (infected material) and germs between the outer covering of the brain and spinal cord and the bones of the...
Read Article Now Book Mark Article - Damage to the part of the ear that helps with balance
Hearing loss from damage to the middle ear may slow language and speech development. This is more likely if both ears are affected.
Permanent hearing loss is rare, but the risk increases with the number and length of infections.
When to Contact a Medical Professional
Call your provider if:
- You or your child has signs of a chronic ear infection
- An ear infection does not respond to treatment
- New symptoms develop during or after treatment
Prevention
Getting prompt treatment for an acute ear infection may reduce the risk of developing a chronic ear infection. Have a follow-up exam with your provider after an ear infection has been treated to make sure that it is completely cured.
References
Chole RA. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 139.
Marcdante KJ, Kliegman RM. Otitis media. In: Marcdante KJ, Kliegman RM, eds. Nelson Essentials of Pediatrics . 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 105.
Rosenfeld RM, Schwartz SR, Pynnonen MA, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg . 2013;149(1 Suppl):S1-S35. PMID: 23818543 www.ncbi.nlm.nih.gov/pubmed/23818543 .
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Ear anatomy - illustration
The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.
Ear anatomy
illustration
-
Middle ear infection (otitis media) - illustration
Otitis media is an inflammation or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.
Middle ear infection (otitis media)
illustration
-
Middle ear infection - illustration
A middle ear infection is also known as otitis media. It is one of the most common of childhood infections. With this illness, the middle ear becomes red, swollen, and inflamed because of bacteria trapped in the eustachian tube.
Middle ear infection
illustration
-
Eustachian tube - illustration
Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult. Bacteria can become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped in the eustachian tube may produce an ear infection that pushes on the eardrum causing it to become red, swollen, and sore.
Eustachian tube
illustration
-
Ear tube insertion - Series
Presentation
-
Ear anatomy - illustration
The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.
Ear anatomy
illustration
-
Middle ear infection (otitis media) - illustration
Otitis media is an inflammation or infection of the middle ear. Acute otitis media (acute ear infection) occurs when there is bacterial or viral infection of the fluid of the middle ear, which causes production of fluid or pus. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly due to allergies, multiple infections, ear trauma, or swelling of the adenoids.
Middle ear infection (otitis media)
illustration
-
Middle ear infection - illustration
A middle ear infection is also known as otitis media. It is one of the most common of childhood infections. With this illness, the middle ear becomes red, swollen, and inflamed because of bacteria trapped in the eustachian tube.
Middle ear infection
illustration
-
Eustachian tube - illustration
Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults, making the movement of air and fluid difficult. Bacteria can become trapped when the tissue of the eustachian tube becomes swollen from colds or allergies. Bacteria trapped in the eustachian tube may produce an ear infection that pushes on the eardrum causing it to become red, swollen, and sore.
Eustachian tube
illustration
-
Ear tube insertion - Series
Presentation
-
Otitis media
(Alt. Medicine)
-
Ear infections
(In-Depth)
Review Date: 4/21/2015
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Internal review and update on 07/24/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial team.
