Ear infection - chronic

Definition

Chronic ear infection is inflammation or infection of the middle ear that persists or keeps coming back, and causes long-term or permanent damage to the ear.

See also: Acute ear infection

Causes, incidence, and risk factors

For each ear, a eustachian tube runs from the middle ear to the back of the throat. This tube drains fluid that is normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, germs such as bacteria and viruses can multiply and cause an infection. This is called an acute ear infection (acute otitis media).

A chronic ear infection occurs 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 clear completely, or repeated ear infections. Fluid in the middle ear may become very thick. Sometimes, the eardrum (tympanic membrane) may stick to the bones in the middle ear.

A chronic ear infection may cause permanent changes to the ear and nearby bones, including:

• Infection in the mastoid bone behind the ear (mastoiditis)
• Ongoing drainage from a hole in the eardrum that does not heal, or after the ear tubes (tympanostomy tubes) are inserted
• Cyst of 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

"Suppurative chronic otitis" is a phrase doctors 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

A chronic, long-term infection in the ear may have less severe symptoms than an acute infection. It may go unnoticed and untreated for a long time.

Symptoms include:

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

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

Signs and tests

An examination of the ear may show:

• Dullness
• Redness
• Air bubbles
• Fluid behind the eardrum
• Draining fluid from the eardrum
• A hole (perforation) in the eardrum
• The eardrum bulges out or pulls back inward

Tests may include:

• Cultures of the fluid may show bacteria, and these bacteria may be resistant or harder to treat than the bacteria commonly involved in an acute ear infection.
• Skull x-rays or 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 may be due to bacteria. You may need to take antibiotics for a long time, either by mouth or sometimes into a vein (intravenously).

If there is a hole in the eardrum, antibiotic ear drops are used. For a difficult-to-treat infected ear that has a hole (perforation), a dilute acidic solution (such as distilled vinegar and water) may help.

A surgeon may need to clean out (debride) tissue that has built up.

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

Expectations (prognosis)

Chronic ear infections usually respond to treatment. However, your child may need to keep taking medicines for several months.

Chronic ear infections are not life threatening, but they can be uncomfortable and may result in hearing loss and other serious complications.

Complications

• Partial or complete hearing loss due to damage of the middle ear
• Slow development of language or speech
• 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

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

Calling your health care provider

Call for an appointment with 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 examination with the health care provider after an ear infection has been treated to make sure that it is completely 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. 4th ed. Philadelphia, Pa: Mosby Elsevier;2005:chap 133.