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 often involves a hole in the eardrum that does not heal.
Does your child have pain or discomfort in his ear? Does your child often have a fever, is fussy a lot? If so, they may have chronic ear infections. Ear infections are one of the most common reasons parents take their children to the doctor. The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. But if the tube gets blocked, fluid can build up, leading to infection. Ear infections are common in infants and children because the Eustachian tubes become easily clogged. If the ears get infected a lot or individual ear infections don’t clear up, your child has chronic ear infections. How do you know for sure that your child has a chronic ear infection? Your child will feel like there’s pressure or fullness in his ear. He may feel pain or discomfort in his ear and have a low-grade fever. An infant may be fussy a lot. You may see a pus-like drainage from an ear, your child may have trouble hearing. Your child’s doctor will check for redness, air bubbles, and thick fluid in your child’s middle ear. If there’s a discharge, a swab of your child’s ear may reveal bacteria that are harder to treat than the bacteria that commonly cause an ear infection. The doctor may see a hole in your child’s eardrum. To treat a chronic ear infection, your child will probably need to take antibiotics if the infection is due to bacteria, maybe for a long time. If there is a hole in the eardrum, your child may need to use antibiotic ear drops as well. If the infection does NOT go away, the child may need surgery, to clean the infection out of the mastoid bone behind the middle ear, to repair the small bones in the middle ear, or to repair the eardrum. The doctor may also recommend ear tube surgery. In this procedure, a tiny tube is inserted into the eardrum to drain the fluid. The tube will usually fall out on its own. Chronic ear infections are treatable, but your child may need to keep taking medicine even for several months. These infections can be uncomfortable, and they may result in hearing loss or other serious problems. The earlier you deal with chronic ear infections, the better.
The ear consists of external, middle, and inner structures. The eardrum and the 3 tiny bones conduct sound from the eardrum to the cochlea.
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.
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.
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.
The tympanic membrane, or eardrum, separates the ear canal from the middle ear.
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
- Repeated ear infections
Suppurative chronic otitis is a term used to describe an eardrum that keeps rupturing, draining, or swelling in the middle ear or mastoid area (the bone behind the ear) 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.
Does your child have pain or discomfort in his ear? Does your child often have a fever, is fussy a lot? If so, they may have chronic ear infections. Ear infections are one of the most common reasons parents take their children to the doctor. The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. But if the tube gets blocked, fluid can build up, leading to infection. Ear infections are common in infants and children because the Eustachian tubes become easily clogged. If the ears get infected a lot or individual ear infections don’t clear up, your child has chronic ear infections. How do you know for sure that your child has a chronic ear infection? Your child will feel like there’s pressure or fullness in his ear. He may feel pain or discomfort in his ear and have a low-grade fever. An infant may be fussy a lot. You may see a pus-like drainage from an ear, your child may have trouble hearing. Your child’s doctor will check for redness, air bubbles, and thick fluid in your child’s middle ear. If there’s a discharge, a swab of your child’s ear may reveal bacteria that are harder to treat than the bacteria that commonly cause an ear infection. The doctor may see a hole in your child’s eardrum. To treat a chronic ear infection, your child will probably need to take antibiotics if the infection is due to bacteria, maybe for a long time. If there is a hole in the eardrum, your child may need to use antibiotic ear drops as well. If the infection does NOT go away, the child may need surgery, to clean the infection out of the mastoid bone behind the middle ear, to repair the small bones in the middle ear, or to repair the eardrum. The doctor may also recommend ear tube surgery. In this procedure, a tiny tube is inserted into the eardrum to drain the fluid. The tube will usually fall out on its own. Chronic ear infections are treatable, but your child may need to keep taking medicine even for several months. These infections can be uncomfortable, and they may result in hearing loss or other serious problems. The earlier you deal with chronic ear infections, the better.
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
- Hearing loss
Symptoms may continue or come and go. They may occur in one or both ears.
Exams and Tests
Your health care provider will look in the ears using an otoscope. The exam 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 ear fluid that may show a bacterial 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 provider may prescribe antibiotics if the infection is caused by bacteria. These medicines may need to be taken for a long time. They may 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)
- Surgery to repair or replace the small bones in the middle ear
- Repair of the eardrum
- Ear tube surgery (myringotomy)
Outlook (Prognosis)
Chronic ear infections 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)
- Ongoing drainage from a hole in the eardrum that does not heal, or after 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 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
Contact 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, Sharon JD. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 140.
Ironside JW, Smith C. Central and peripheral nervous systems. In: Cross SS, ed. Underwood's Pathology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 26.
Kerschner JE, Preciado D. Otitis media. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 658.
Pelton SI. Otitis externa, otitis media, and mastoiditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 61.
Rosenfeld RM, Tunkel DE, Schwartz SR, et al. Clinical Practice Guideline: Tympanostomy tubes in children (update). Otolaryngol Head Neck Surg. 2022;166(1_suppl):S1-S55. PMID: 35138954
Steele DW, Adam GP, Di M, Halladay CH, Balk EM, Trikalinos TA. Effectiveness of tympanostomy tubes for otitis media: a meta-analysis. Pediatrics. 2017;139(6):e20170125. PMID: 28562283
Version Info
Last reviewed on: 1/24/2023
Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Internal review and update on 02/03/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
