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What Is It?

Chronic otitis media describes some long-term problems with the middle ear, such as a hole (perforation) in the eardrum that does not heal or a middle ear infection (otitis media) that doesn't improve or keeps returning.

The middle ear is a small bony chamber with three tiny bones the malleus, incus and stapes covered by the eardrum (tympanic membrane). Sound is passed from the eardrum through the middle ear bones to the inner ear, where the nerve impulses for hearing are created. The middle ear is connected to the back of the nose and throat by the Eustachian tube, a narrow passage that helps to control the air flow and pressure inside the middle ear. The middle ear can become inflamed or infected when the Eustachian tube becomes blocked, for example, when someone has a cold or allergies. When fluid remains in the middle ear, the condition is called chronic serous otitis media.

Sometimes a middle ear infection causes a hole (perforation) in the eardrum. A hole that does not heal within six weeks is called chronic otitis media. This problem can take one of three forms:

  • Non-infected chronic otitis media There is a hole in the eardrum but no infection or fluid in the middle ear. This condition can exist indefinitely. As long as the ear remains dry, the middle and inner ears can remain stable for years. Repairing the hole is only necessary to improve hearing or to prevent infection.

  • Suppurative (filled with pus) chronic otitis media This happens when there is a hole in the eardrum and an infection in the middle ear. Cloudy and sometimes foul-smelling fluid drains out through the opening. Treatment with antibiotics usually helps to clear the active infection.

  • Chronic otitis media with cholesteatoma A persistent hole in the eardrum sometimes can lead to a cholesteatoma, a growth (tumor) in the middle ear made of skin cells and debris. A cholesteatoma also can form when there is no hole, but the Eustachian tube is blocked. (Congenital cholesteatomas are present at birth and are not caused by a hole.) The exact cause is not known, but the eardrum is intact. Cholesteatomas can cause hearing loss and are prone to get infected, which can cause ear drainage. Cholesteatomas will grow large enough to erode the middle ear structures and the mastoid bone behind the middle ear.

Problems with the middle ear, such as fluid in the middle ear, a hole in the eardrum, or injury to the small, middle ear bones, can cause hearing loss. In rare situations, infections in the middle ear can spread deeper inside the inner ear, causing a sensorineural hearing loss and dizziness. Rare, but serious, complications include brain infections, such as an abscess or meningitis. A chronic infection and a cholesteatoma also can cause injury to the facial nerves and facial paralysis.

Children are more likely to get middle ear infections. Because of this, they also are more likely to develop chronic otitis media. Doctors believe that children have an especially high risk of all types of ear infections because of several factors, including:

  • Immature immune (infection-fighting) system

  • Undiagnosed allergies

  • Eustachian tubes that are smaller and less angled compared to adults

  • Unusually large or infected adenoids (masses of infection-fighting tissue in the back of the nose, near the opening of the Eustachian tubes)

  • Exposure to cigarette smoke

  • Attendance at day care

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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