Ear infection - chronic
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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
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.
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:
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.
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:
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.
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
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
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
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.
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.
- Last reviewed on 5/16/2012
- 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.
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This page was last updated: May 20, 2014