Ear infection - chronic

Answer 1

Definition

Chronic ear infection is inflammation or infection of the middle ear that persists or keeps coming back, and causes long-term or permanent damage to the ear.

See also: Acute ear infection

Alternative Names

Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection

Causes, incidence, and risk factors

For each ear, a eustachian tube runs from the middle ear to the back of the throat. This tube drains fluid that is normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, germs such as bacteria and viruses can multiply and cause an infection. This is called an acute ear infection (acute otitis media).

A chronic ear infection occurs 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 clear completely, or repeated ear infections. Fluid in the middle ear may become very thick. Sometimes, the eardrum (tympanic membrane) may stick to the bones in the middle ear.

A chronic ear infection may cause permanent changes to the ear and nearby bones, including:

• Infection in the mastoid bone behind the ear (mastoiditis)
• Ongoing drainage from a hole in the eardrum that does not heal, or after the ear tubes (tympanostomy tubes) are inserted
• Cyst of 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

"Suppurative chronic otitis" is a phrase doctors 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

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 include:

• Ear pain or discomfort, earache
  • Usually mild
  • May feel like pressure in the ear
• Fever
• Fussiness
• Pus-like drainage from the ear
• Hearing loss

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

Signs and tests

An examination of the ear may show:

• Dullness
• Redness
• Air bubbles
• Fluid behind the eardrum
• Draining fluid from the eardrum
• A hole (perforation) in the eardrum
• The eardrum bulges out or pulls back inward

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.
• Skull x-rays or 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 sometimes 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

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

• Partial or complete hearing loss due to damage of the middle ear
• Slow development of language or speech
• 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

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. 4th ed. Philadelphia, Pa: Mosby Elsevier;2005:chap 133.

Morris PS, Leach AJ. Acute and chronic otitis media. Pediatr Clin North Am. 2009 Dec;56(6):1383-99.

Answer 2

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

Alternative Names

Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection

Causes, incidence, and risk factors

The eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the eustachian tube becomes blocked, fluid can build up. When this happens, infection can occur. See: Acute ear infection

A chronic ear infection occurs 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 clear completely
• Repeated ear infections

"Suppurative chronic otitis" is a phrase doctors 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

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. 4th ed. Philadelphia, Pa: Mosby Elsevier;2005:chap 133.

Morris PS, Leach AJ. Acute and chronic otitis media. Pediatr Clin North Am. 2009 Dec;56(6):1383-99.

Reviewed By

Review Date: 05/01/2011

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., Inc.

Answer 3

Does your child have pain or discomfort in his ear? Does your child often have a fever and is fussy a lot? If so, they may have chronic ear infections.

Ear infections are one of the most common reasons parents take their children to the doctor. The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid normally made in the middle ear. If the tube gets blocked, fluid can build up, leading to infection. Ear infections are common in infants and children because the Eustachian tubes become easily clogged. If the ears get infected a lot or individual ear infections don't clear up, your child has chronic ear infections.

How do you know for sure that your child has a chronic ear infection?

Your child will feel like there's pressure or fullness in his ear. He may pain or discomfort in his ear a lot and have a low-grade fever. An infant may be fussy a lot. You may see a pus-like drainage from an ear, and your child may have trouble hearing.

Your child's doctor will check for redness, air bubbles, and thick fluid in your child's middle ear. A swab of your child's ear may reveal bacteria that are harder to treat than bacteria that commonly cause an ear infection. The doctor may see a hole in your child's eardrum.

To treat a chronic ear infection, your child will probably need to take antibiotics if the infection is due to bacteria, maybe for a long time. If there is a hole in the eardrum, your child may need to use antibiotic ear drops or a mixture of vinegar and water.

If the infection does NOT go away, the child may need surgery, to clean the infection out of the mastoid bone in the middle ear, to repair or replace the small bones in the middle ear, or to repair the eardrum. The doctor may also recommend ear tube surgery. In this procedure, a tiny tube is inserted into the eardrum to drain the fluid. The tube will usually fall out on its own.

Chronic ear infections are treatable, but your child may need to keep taking medicine even for several months. These infections can be uncomfortable, and they may result in hearing loss or other serious problems.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.