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Chronic Otitis Media

Last updated May 20, 2018

Approved by: Maulik P. Purohit MD, MPH

Chronic Otitis Media is a long-term infection of the middle ear commonly caused by bacteria, viruses, and fungus. It is also known as Chronic Ear Infection and affects children more than adults.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Chronic Ear Infection
  • Middle Ear Infection - Chronic

What is Chronic Otitis Media? (Definition/Background Information)

  • Chronic Otitis Media is a long-term infection of the middle ear commonly caused by bacteria, viruses, and fungus. It is also known as Chronic Ear Infection and affects children more than adults.
  • The condition is marked by inflammation and accumulation of fluid in the middle ear. The middle ear is an air-filled space behind the eardrum that contains the tiny vibrating bones of the ear.
  • Chronic ear infections are marked by signs and symptoms that include severe retraction or perforation in the eardrum, scarring or erosion of the small bones of the middle ear, and recurrent discharge from the ear.
  • The treatment of Chronic Otitis Media is based upon the severity of infection and varies from measures such as the use of antibiotic drops to surgery. The condition usually respond well to treatment, but the child will need to take medicines for a very period of long time.
  • Chronic Otitis Media can be prevented by appropriately treating the acute ear infection.

Ear infections are classified into the following types:

  • Acute Otitis Media: An ear infection accompanied by pain that lasts only for a short duration of time
  • Chronic Otitis Media: An ear infection that lasts for a longer time or occurs on and off

Who gets Chronic Otitis Media? (Age and Sex Distribution)

  • Chronic Otitis Media may affect any individual irrespective of age and gender; but, children and infants are more likely to be affected than adults, because their eustachian tubes are shorter, narrower, and more horizontal, than adults
  • Males are affected more than females
  • The condition is seen worldwide; no racial or ethnic preference is observed

What are the Risk Factors for Chronic Otitis Media? (Predisposing Factors)

The risk factors associated with Chronic Ear Infection are:

  • Male gender
  • A family history of ear infections
  • Individuals with abnormalities of the palate
  • Poor immune system
  • The presence of chronic respiratory diseases such as cystic fibrosis and asthma
  • Attending daycare centers: Studies have shown that children who attend daycare centers have a higher incidence of ear infections than kids who do not attend such centers. However, other studies have also shown that such infections acquired from a daycare may help children build their immune system
  • Changes in altitude and changes in climate; cold climate
  • Exposure to smoke: Both firsthand and secondhand smoke can increase the incidence of Acute Ear Infection
  • Genetic factors
  • Not being breastfed: Breast milk has high-quality proteins that boost the immune system of the child
  • Use of a pacifier
  • Recent or past ear infection
  • Recent illness of any type that reduces immunity level
  • Allergies to pollen dust, animal dander, or food
  • Upper respiratory viral infections such as cold and flu
  • Sinus infections
  • Conditions affecting the adenoid glands
  • Post nasal drainage

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chronic Otitis Media? (Etiology)

The middle ear is a small space behind the eardrum that is well-ventilated by air that passes up from behind the nose through the eustachian tube, keeping the middle ear clean and dry. When this tube is blocked or clogged, the middle ear becomes damp, stagnant, and warm and becomes a perfect ground for the growth of pathogens. Chronic Otitis Media is caused by viral, bacterial, or fungal pathogens.

  • Bacterial pathogen causing ear infections are Streptococcus Pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, and Moraxella catarrhalis
  • Viruses responsible for the condition include respiratory syncytial virus

An obstruction or blockage in the eustachian tube may occur due to the following factors:

  • Allergies
  • Post nasal drainage
  • Sinus infections
  • Adenoid-related conditions
  • Eustachian tube being soft and immature in children
  • Upper respiratory viral infections
  • A Chronic Ear Infection is usually the sequelae of an untreated acute ear infection, or the result of recurring ear infections.

What are the Signs and Symptoms of Chronic Otitis Media?

Chronic Otitis Media may be characterized by the presence of the following affecting the ear:

  • Severe retraction or perforation in the eardrum
  • Scarring or erosion of the middle ear small bones
  • Recurrent or chronic ear discharge/drainage
  • Inflammation causing erosion of the bone covering the facial nerve, balance canals, or cochlea
  • Erosion of the bony borders of the middle ear, resulting in infection spreading to the brain
  • Presence of cholesteatoma, which is an abnormal skin growth
  • Persistence of fluid behind the eardrum
  • Persistent blockage in the ear, fullness of the ear

Other signs and symptoms may include:

  • Problems with balance
  • Facial weakness
  • Persistent ear pain and headache
  • Fever
  • Confusion
  • Sleepiness
  • Swelling behind the ear

How is Chronic Otitis Media Diagnosed?

The diagnosis of Chronic Otitis Media may include:

  • A thorough evaluation of the individual’s medical history
  • A complete examination of the ear, nose, and throat, which may reveal:
    • Area of dullness and redness
    • Air bubbles, thick fluid in the middle ear
    • Draining fluid from the ear drum
    • A hole in the eardrum (eardrum perforation)
    • The eardrum bulges out or is pulled back inward
  • Tests may include:
    • Fluid culture to detect the bacteria responsible for the infection
    • A CT scan of the head or mastoids to check spread of infection
    • Hearing test
    • Tympanometry: A test to measure the pressure inside the ear
    • MRI scan of the head and neck

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chronic Otitis Media?

The complications associated with Chronic Otitis Media could include:

  • Mastoiditis: Infection of the mastoid bone behind the ear
  • Cholesteatoma: Formation of destructive skin cyst in the middle ear
  • Drainage from a hole in the eardrum
  • Tympanosclerosis: Hardening of the tissues in the middle ear
  • Paralysis of the facial nerve resulting in conditions such as wrinkling of the forehead, closing of the eyelid, smiling, and even whistling
  • Damage to the bones of the middle ear
  • Epidural abscess: Abscess formation  around or in the brain
  • Damage to that part of the ear that helps in balance
  • Speech and language development issues
  • Permanent hearing loss, though it is very rare

How is Chronic Otitis Media Treated?

The treatment of Chronic Otitis Media depends upon the stage of the infection.

  • Uncomplicated Chronic Ear Infection is treated with the use of steroids and antibiotics
  • In severe cases where regular medications are unsuccessful, surgery is recommended with an objective of:
    • Disease eradication
    • Remodeling the middle ear
    • Preserving the mastoid bone
    • Improvement in hearing

The recommended surgical procedures include:

  • Tympanoplasty: Surgery to reconstruct the eardrum and small bones of the middle ear
  • Mastoidectomy: Surgery to remove the mastoid air cells
  • Typanomastoidectomy: A surgical procedure to clear the infection both in the middle ear and mastoid

How can Chronic Otitis Media be Prevented?

Following preventive methods may be followed to reduce the risk of Chronic Otitis Media, namely:

  • Getting prompt treatment of acute ear infections
  • Regular follow-up examination after treatment of respiratory and ear infections with the healthcare provider, especially in children

What is the Prognosis of Chronic Otitis Media? (Outcomes/Resolutions)

  • Chronic Otitis Media usually respond well to treatment, but the child (or adult individual) will need to take medicines for a very long time
  • Chronic Ear Infections can be recurrent and uncomfortable, but then they are not life-threatening

Additional and Relevant Useful Information for Chronic Otitis Media:

All children should have an updated vaccination status, meaning that all children shall be current on their vaccinations.

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 27, 2015
Last updated: May 20, 2018