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Ear infection - chronic


Definition:

Chronic ear infection is fluid, swelling, or an infection behind the eardrum that does not go away or keeps coming back, and causes long-term or permanent damage to the ear.

See also: Acute ear infection

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 may include:

  • Ear pain or discomfort that is usually mild and feels like pressure in the ear
  • Fever, usually low-grade
  • Fussiness in young infants
  • Pus-like drainage from the ear
  • Hearing loss

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

Signs and tests:

The health care 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 may stick to the bones in the middle ear
  • Draining fluid 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, and these bacteria may be resistant or 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 may be due to bacteria. You may need to take antibiotics for a long time, either by mouth or 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 be recommended by your health care provider.

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
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:

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

Partial or complete hearing loss due to damage of the middle ear may lead to:

  • Slow development of language or speech (more common if both ears are affected)

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. 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.


Review Date: 5/16/2012
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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