Chronic Otitis Media

Chronic otitis media is a long-standing infection of the middle ear.

Chronic otitis media is caused by a permanent hole (perforation) in the eardrum or a noncancerous growth of white skinlike material (cholesteatoma). People may have a perforation without ever getting any symptoms, but sometimes a chronic bacterial infection develops.

Chronic otitis media may flare up after an infection of the nose and throat, such as the common cold, or after water enters the middle ear while bathing or swimming. Usually, flare-ups result in a painless discharge of pus, which may be malodorous, from the ear. Persistent flare-ups may result in the formation of protruding growths called polyps, which extend from the middle ear through the perforation and into the ear canal. Persistent infection can destroy parts of the ossicles--the small bones in the middle ear that connect the eardrum to the inner ear and conduct sounds from the outer ear to the inner ear--causing conductive hearing loss (see Section 19, Chapter 218). Other serious complications include inflammation of the inner ear, facial paralysis, and brain infections. Some people with chronic otitis media develop cholesteatomas in the middle ear. Cholesteatomas, which destroy bone, greatly increase the likelihood of other serious complications. A doctor diagnoses chronic otitis media when seeing pus or skinlike material accumulating in a hole or in a pocket in the eardrum that often drains.

Treatment

When chronic otitis media flares up, a doctor thoroughly cleans the ear canal and middle ear with suction and dry cotton wipes, then prescribes a solution of acetic acid with hydrocortisone or antibiotic ear drops. Water must be kept out of the ear when a perforation is present.

Usually, the eardrum can be repaired in a procedure called tympanoplasty. If the ossicle chain has been disrupted, it may be repaired at the same time. Cholesteatomas must be removed surgically. If a cholesteatoma is not removed, serious complications can develop.