Persistent Otitis Media - Chronic Otitis Media

Chronic otitis media is a term used to describe persistent or chronic middle ear inflammation. This may be due to persistent fluid behind the eardrum from repeated middle ear infections.

What is going on in the body?

Fluid behind the eardrum is common with a middle ear infection. Middle ear infections are common in children during the first few years of life. This fluid goes away in almost all children within three months of the infection. In a few children who have chronic middle ear infections, the fluid does not go away on its own. This collection of fluid is called effusion, which means fluid behind the eardrum.

Repeated episodes of middle ear infections may also be due to a tear in the eardrum or to cysts, which are abnormal sacs, in the ear. These conditions make the ear more prone to become infected with bacteria.

What are the causes and risks of the condition?

The cause of otitis media is usually a sudden middle ear infection. In large studies in daycare centers, up to 70% of children had fluid behind their eardrums at some point during a year. About 90% of the time, the fluid went away without treatment.

Other causes include chronic sinus infection and allergies. Children who have certain abnormalities in the shape of the face, palate, or eustachian tube, which connects the middle ear cavity with the throat, may also put a child at higher risk. Even though it is extremely rare, fluid behind just one eardrum can indicate a cancer. This is particularly true in adults.

Children with Down syndrome and those who are Native American seem to have a higher risk of this condition.

What are the signs and symptoms of the condition?

In cases of middle ear inflammation with fluid behind the eardrum, the most common symptom is loss of hearing. If children are old enough, they may say that the ear feels plugged or full. Pain and fever, which occur with more acute ear infections, are rare.

The signs of hearing loss in children may be quite hard to detect. If a child seems to ignore the parent, sits close to the TV, or fails to develop speech at a normal age, hearing loss could be the reason. The hearing loss is usually mild, and its effect on speech is quite subtle. In these milder forms of hearing loss, low-power sounds, such as F, S, or TH, are the first to be pronounced poorly.

In middle ear inflammation with fluid behind the eardrum, different kinds of fluid can be present. The fluid can range from a clear or yellow liquid to a thick, white material that resembles rubber cement. Thicker fluid usually means more inflammation in the ear.

If the eardrum has a tear or there is a cyst in the ear, symptoms may include hearing loss and discharge from the ear, which can range from a watery consistency to a yellow-green, foul-smelling discharge. Other symptoms may develop if there are complications.

How is the condition diagnosed?

There are two main ways to diagnose chronic otitis media. The first is a physical exam, which will find fluid behind the eardrum and poor movement of the eardrum. The second way is to measure the amount of eardrum mobility with a special test. The test is abnormal when fluid is behind the eardrum. A hearing test will often reveal some hearing loss as well.

In chronic middle ear inflammation due to a tear in the eardrum or an ear cyst, the diagnosis is usually made with a physical exam. Hearing tests are usually abnormal in this case as well. Special x-ray tests, such as a CAT scan, may be done in some cases.

What can be done to prevent the condition?

To prevent otitis media, children should receive prompt treatment for ear infections. If antibiotics are prescribed, the pills or liquid must be taken until gone, even if the child feels better. Children may be given special vaccines to help prevent future infections as well.

What are the long-term effects of the condition?

With prompt treatment, there usually are no long-term effects, unless treatment fails. Untreated cases or treatment failure may result in:

What are the risks to others?

Chronic middle ear infections are not catching and pose little risk to others.

What are the treatments for the condition?

Antibiotics and corticosteroid medicines are often given. If otitis media does not respond to those medicines, ventilation tubes are a treatment option. Ventilation tubes are tiny tubes that are inserted through the eardrum to help equalize the pressure inside the ear and allow fluid drainage.

With a a hole in the eardrum, called a perforation\ \calcium deposits\ \a deformity known as a retraction pocket\',CAPTION,'Eardrum Repair');" onmouseout="return nd();">perforated eardrum or ear cyst, surgery is usually advised. This may include repairing the eardrum and removing any infected tissue, diseased or scarred membranes, or cysts that are in or around the ear. The hearing bones may also need repair.

What are the side effects of the treatments?

Ventilation tubes usually cause few side effects. A hole in the eardrum remains in 2% to 3% of children once the tubes are removed. Other complications can include:

The tubes last for 6 to 12 months on average. Another set of tubes is needed in about 20% of those children.

Surgery in and around the ear may fail to get rid of the infection completely or fail to restore all of the hearing loss. Side effects can include a disturbance of taste on part of the tongue. Other side effects may include nerve damage leading to deafness, dizziness, facial paralysis on one side, or breakdown of the repaired eardrum. If synthetic materials are used to restore the bones for hearing, the materials can become dislodged or fail.

What happens after treatment for the condition?

In chronic otitis media, hearing is usually restored very quickly after treatment. If ventilation tubes are required, drainage through the tube may continue for a short while. After tubes are placed, some care needs to be taken to prevent bacteria in the middle ear space. Sometimes chlorinated water, such as that in swimming pools or out of the tap, can get into the middle ear space through the tube.

Swimming with tubes is a controversial topic. Many doctors advise that children with tubes should not swim at all. If children do swim, they should wear earplugs and a headband. Most doctors advise children with tubes not to dive. Often, antibiotic eardrops are used after swimming or if there is some concern that water has gotten into the ears.

The risk of an infection is highest if shampoo or soapy bath water enters the middle ear through the tube. Bath water often contains bacteria from the bowel and skin. Soap helps bath water slide more easily into the middle ear.

In most people who have had surgery for chronic middle ear inflammation, healing is complete within two to three months. If the treatment is a success, there will be no further infections, and hearing is improved. But if the infection continues, the eardrum may perforate again, or fluid may develop behind it.

How is the condition monitored?

Hearing loss after an upper respiratory infection or a treated acute ear infection should prompt a visit to the doctor. After tube placement, if drainage continues or hearing does not improve, a doctor should be consulted.

Any new or worsening symptoms should be reported to a doctor. Anyone with ear drainage needs to be seen by a doctor right away. This is especially true if there is hearing loss, dizziness, facial paralysis, or high fevers.

Author:Mark Loury, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:09/25/02
Reviewer:Kathleen A. MacNaughton, RN, BSN
Date Reviewed:09/25/02