Chronic Ear Infections

Chronic ear infections, also called chronic otitis media, is an inflammation or infection of the middle ear. Chronic means recurring or persistent.

Complications of chronic ear infections include:

• Permanent damage to the ear with partial or complete deafness
• Mastoiditis
• Cholesteatoma (middle ear skin growth)
• Meningitis and epidural abscess (inflammation and infection around the brain)
• Facial paralysis

Symptoms

• Ear pain or discomfort, earache, usually mild, may feel like pressure in the ear
• Pus-like drainage from the ear
• Hearing loss

Symptoms may be continuous or intermittent, and may occur in one or both ears.

Causes

Inflammation or infection of the middle ear occurs when the eustachian tube to that ear is blocked. The eustachian tube is the passage from the back of the nose to the space behind the ear drum.

Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly (or remains blocked for long periods) due to allergies, multiple infections, ear trauma or swelling of the adenoids.

Bacteria from the back of the nose (nasopharynx) will go through the eustachian tube and cause an infection in the space behind the ear drum (middle ear). 

When the middle ear is acutely infected with bacteria (or occasionally, viruses) it is called acute otitis media. A chronic ear infection may be the result of an acute ear infection that does not clear completely, or the result of recurrent ear infections.

The infection may spread into the mastoid bone behind the ear (mastoiditis), or pressure from fluid build-up may rupture the eardrum or damage the bones of the middle ear.

A chronic ear infection may be more destructive than an acute ear infection because its effects are prolonged or repeated. It may cause permanent damage to the ear.

However, a chronic, long-term infection may show less severe symptoms so the infection may remain unnoticed and untreated for a long time.

Ear infections are more common in children because their eustachian tubes are shorter, narrower and more horizontal than those of adults. Chronic ear infections are much less common than acute ear infections.

Diagnosis

An examination of the ear may show dullness, redness, air bubbles, or fluid behind the eardrum. The eardrum may bulge outward or retract inward, or it may show drainage or perforation (a hole in the eardrum).

If a hole in the ear drum is present (as a result of infections or trauma) it can be repaired surgically. Surgical repair of a ruptured eardrum may prevent further chronic ear infections.

To diagnose the infection:

• The drainage may be cultured. If there is bacteria present, they may be resistant or harder to treat than bacteria commonly involved in acute ear infections.
• A CT scan may be done. The scan of the ear bones may show spreading of the infection beyond the middle ear into the mastoid bone (bone behind the ear).

Treatment

Removal of the infection from the mastoid bone (the bone behind the ear) may be necessary (called a mastoidectomy) in conjunction with the repair of the ear drum. The success rate of the repair of the ear drum is approximately 90 percent.

Otoendoscopy (small angled cameras) allows the surgeon to remove disease from areas that cannot be seen with a microscope. The combination of microscopes and endoscopy helps to create the least invasive treatment for patients with chronic ear infections.

At UCI Health, otoendoscopy (in addition to a microscope) is used routinely used in chronic ear infection surgery for a less invasive approach. This reduces the likelihood of second surgeries.

Patients who have had previous surgery for the repair of their ear drum perforation will often not have any muscle covering left for the repair. To correct this, incisions are made behind the opposite ear, or a long incision is done behind and above the ear to get more fascia. 

Chronic otitis usually responds to treatment, but treatment may be prolonged (over several years). The disorder is usually not a threat to life but may be uncomfortable and may result in serious complications if left untreated.