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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
  • 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
  • Hearing loss

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.
  • 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)
  • Surgery to repair or replace the small bones in the middle ear
  • Repair of the eardrum
  • Ear tube surgery

 

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)
  • 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 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.

 
  • Ear anatomy

    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)

    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

    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

    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

    Ear tube insertion - Series

    Presentation

    • Ear anatomy

      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)

      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

      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

      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

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

      Tests for Ear infection - chronic

       

       

      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.

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