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Ear infection - chronic

Chronic ear infection is fluid, swelling, or an infection behind the eardrum. The condition does not go away or keeps coming back, and causes lasting damage to the ear. An ear infection that is short and painful but clears up is called an acute ear infection .

Alternative Names

Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection

Middle ear infection (otitis media)

Causes

The eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid that is made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, infection can occur.

Middle ear infection

A chronic ear infection occurs when fluid or an infection behind the eardrum does not go away. This may be caused by:

  • An short-term ear infection that does not clear completely
  • Repeated ear infections
Eustachian tube

Ear infections are more common in children because their eustachian tubes are shorter and narrower than in adults. The tubes in childrenĀ are also more horizontal, so fluid does not drain as well. Chronic ear infections are much less common than acute ear infections.

Symptoms

Symptoms from a chronic, long-term infection in the ear may be less severe than a short-term infection. It may go unnoticed and untreated for a long time.

Symptoms may include:

Symptoms may be constant or come and go. Symptoms may also occur in one or both ears.

Exams and Tests

The health care provider will look in the ears. The exam may show:

  • Parts of the middle ear that look dull or red
  • Air bubbles in the middle ear
  • Thick fluid in the middle ear
  • Eardrum may beĀ sticking to the bones in the middle ear
  • Fluid draining from the eardrum
  • A hole (perforation) in the eardrum
  • The eardrum bulges out or pulls back inward (collapses)

Tests may include:

  • Cultures of the fluid may show bacteria. 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.
  • Hearing tests may be needed.

Treatment

The health care provider may prescribe antibiotics if the infection might be due to bacteria. Long-term antibiotics may be needed. These can either be taken by mouth or given through a vein (intravenously).

Antibiotic ear drops are used if there is a hole in the eardrum. The health care provider may tell you to use a solution of vinegar and water for a hard-to-treat infected ear that has a hole in the eardrum. 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 )
  • Surgery to repair or replace the small bones in the middle ear
  • Repair of the eardrum
  • Ear tube surgery

Outlook (Prognosis)

Most chronic ear infections respond to treatment. However, medicines may be needed for several months.

Chronic ear infections are not life-threatening. However, they can be painful and may cause hearing loss and other complications.

Possible Complications

A chronic ear infection may cause lasting changes to the ear and nearby bones. These may include:

  • Infection of the mastoid bone behind the ear (mastoiditis )
  • 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 )
  • 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
  • Inflammation around the brain (epidural abscess ) or in the brain
  • Damage to the part of the ear that helps with balance

Hearing loss due to damage of the middle ear may lead to slow development of language or speech. This is more common when both ears are affected.

Permanent hearing loss is rare. The risk increases with the number and length of infections.

When to Contact a Medical Professional

Call your health care 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 the health care provider after an ear infection has been treated to make sure that it is cured.

References

Chole RA, Sudhoff HH. Chronic otitis media, mastoiditis, and petrositis. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 139.

Morris PS, Leach AJ. Acute and chronic otitis media. Pediatr Clin North Am. 2009 Dec;56(6):1383-99.

Updated: 5/10/2013

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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