Chronic otitis media

Alternative names
Middle ear infection - chronic; Ear infection - chronic; Otitis media - chronic; Chronic ear infection

Definition
Otitis media is an inflammation or infection of the middle ear. Chronic means recurring or persistent.

Causes, incidence, and risk factors

Inflammation or infection of the middle ear occurs when the eustachian tube to that ear is blocked. The eustachian tube is the passage from the back of the throat to the middle ear. Chronic otitis media 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.

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 pressure from fluid build-up may rupture the eardrum or damage the bones of the middle ear.

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

     
  • Ear pain or discomfort, earache       o Usually mild       o May feel like pressure in the ear  
  • Pus-like drainage from the ear  
  • Hearing loss

Note: Symptoms may be continuous or intermittent, and may occur in one or both ears.

Signs 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.

Mastoid x-rays or a CT scan of the head or mastoids may show spreading of the infection beyond the middle ear.

Treatment

Treatment is focused on relief of symptoms and cure of the infection.

Antibiotics may be prescribed if the infection appears bacterial. Antibiotic treatment is usually long-term and may be oral or in the form of antibiotic ear drops if there is a hole in the eardrum.

Surgical removal of the adenoids may be necessary to allow the eustachian tube to open. A surgical opening may be made in the eardrum (myringotomy) to allow fluid to drain. This may or may not include placement of drainage tubes in the ear. Surgical repair of 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.

Expectations (prognosis)
Chronic otitis usually responds to treatment, but treatment may be prolonged (over several months). The disorder is usually not a threat to life but may be uncomfortable and may result in serious complications.

Complications

     
  • Permanent damage to the ear with partial or complete deafness  
  • Mastoiditis  
  • Cholesteatoma (middle ear cyst)  
  • Epidural abscess (inflammation around the brain)  
  • Facial paralysis

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 persists 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 the more infections a child has.

Calling your health care provider
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.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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