An ear infection (otitis media) occurs when the air-filled space behind the eardrum becomes inflamed. While most middle ear infections are acute and resolve quickly, the condition can persist or recur repeatedly, leading to a chronic state. This long-term challenge requires a different approach to diagnosis and treatment than a standard, one-time earache.
Defining Chronic Ear Infection
A chronic ear infection is defined by its duration, lasting more than three months or recurring frequently. Unlike an acute infection, which features rapid onset and significant pain, a chronic issue involves less intense symptoms that do not resolve. This long-term inflammation and fluid presence can damage the delicate structures of the middle ear.
Chronic otitis media is categorized into two primary types. Chronic Otitis Media with Effusion (COME) involves fluid accumulation in the middle ear without active bacterial infection or a hole in the eardrum. This fluid, often called “glue ear,” causes muffled hearing.
The second type is Chronic Suppurative Otitis Media (CSOM), characterized by a persistent perforation in the eardrum with drainage (otorrhea) lasting several weeks. This drainage indicates a long-standing infection and tissue damage due to chronic exposure to bacteria.
Underlying Causes and Risk Factors
The primary anatomical cause of chronic ear infections is dysfunction of the Eustachian tube, the passage connecting the middle ear to the back of the throat. This tube ventilates the middle ear, equalizes pressure, and drains fluid. When the tube fails to open or close correctly, often due to swelling or obstruction, air pressure cannot be regulated.
This failure creates a vacuum effect, drawing fluid from the mucosal lining into the middle ear space. In children, the Eustachian tube is shorter and more horizontal, making it more prone to blockage and inefficient drainage. Fluid retention provides an environment where pathogens can multiply, leading to persistent infection.
Risk Factors
Several factors increase the likelihood of chronic otitis media, especially in children. These include frequent acute ear or upper respiratory tract infections. Exposure to secondhand smoke is a significant irritant that causes inflammation of the Eustachian tube lining. Other factors are attending daycare, which increases exposure to pathogens, and structural issues like a cleft palate or immune deficiencies.
Recognizable Signs and Symptoms
Symptoms of a chronic ear infection differ from the throbbing pain of a sudden infection. A common sign is persistent, mild discomfort or a feeling of fullness and pressure in the ear, often caused by long-term fluid presence (COME).
Conductive hearing loss is a primary symptom, where sounds are muffled because fluid prevents sound waves from vibrating the tiny bones in the middle ear. Parents may notice children frequently asking for repetition. Balance issues or vertigo may occasionally occur if the infection has caused pressure changes.
For Chronic Suppurative Otitis Media (CSOM), the defining symptom is persistent or intermittent ear drainage (otorrhea) through the perforated eardrum. This drainage may be thick or have a foul odor. Ear pain is often minimal or absent with CSOM because the perforation relieves pressure buildup.
Treatment Approaches and Management
Management of chronic ear infections is tailored to the specific condition and symptom severity.
Treatment for COME
For Chronic Otitis Media with Effusion (COME), a “wait-and-see” approach is often adopted initially, as the fluid frequently clears on its own within three months. During this observation period, medications like steroid nasal sprays may be used to reduce Eustachian tube swelling and promote natural drainage.
If the effusion persists beyond three months, or if significant hearing loss is confirmed, surgical intervention is recommended. The most common procedure is the insertion of tiny tubes, called tympanostomy tubes, into a small incision in the eardrum. These tubes ventilate the middle ear, equalize pressure, and allow trapped fluid to drain, often resulting in immediate hearing improvement.
Treatment for CSOM
For Chronic Suppurative Otitis Media (CSOM), medical treatment focuses on eliminating bacteria causing persistent drainage, commonly involving topical antibiotic ear drops. Oral antibiotics may also be used, often guided by a culture of the discharge to identify the specific pathogen. The patient must keep the ear dry during treatment to prevent bacteria from entering the middle ear through the perforation.
If the persistent eardrum perforation does not heal, or if the infection has caused significant tissue damage, more extensive surgery may be necessary. A tympanoplasty is a procedure to repair the damaged eardrum and restore its integrity, protecting the middle ear from future infections. In rare, severe cases where the infection has spread to the mastoid bone, a mastoidectomy may be performed to remove the diseased bone.