Chronic Otitis Media

Overview, Causes, & Risk Factors

Chronic otitis media is a term used to describe persistent orchronic middle ear inflammation. This may be due to persistent fluidbehind the eardrum from repeated middle ear infections.

What is going on in the body?

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

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

What are the causes and risks of the condition?

The cause of otitis media is usually a suddenmiddle ear infection. In large studies in daycare centers, up to70% of children had fluid behind their eardrumsat some point during a year. About 90% of the time, the fluid went awaywithout treatment.

Other causes include chronic sinus infectionand 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 isextremely rare, fluid behind just one eardrum can indicate a cancer.This is particularly true in adults.

Children with Down syndromeand those who are Native American seem to have a higher risk of thiscondition.

Symptoms & Signs

What are the signs and symptoms of the condition?

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

The signs of hearing loss in children may be quite hard todetect. If a child seems to ignore the parent, sits close tothe TV, or fails to develop speech at a normal age, hearing loss couldbe the reason. The hearing loss isusually mild, and its effect on speech is quite subtle. In these milderforms of hearing loss, low-power sounds, such as F, S, or TH, are thefirst 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 clearor 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 arecomplications.

Diagnosis & Tests

How is the condition diagnosed?

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

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

Prevention & Expectations

What can be done to prevent the condition?

To prevent otitis media, children should receive prompttreatment for ear infections. If antibiotics are prescribed, the pills or liquidmust be taken until gone, even if the child feels better. Children maybe 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:

  • hearing loss
  • speech and learning delays secondary to hearing loss
  • scarring of the eardrum
  • damage to the bones that assist with hearing and some of the skullbones
  • damage to the nerves responsible for hearing, which can causepermanent, untreatable deafness
  • extension of the infection into the skull or even the brain, which cancause death in rare cases
  • What are the risks to others?

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

    Treatment & Monitoring

    What are the treatments for the condition?

    Antibiotics and corticosteroid medicines are often given.If otitis mediadoes not respond to those medicines, ventilationtubes are a treatment option. Ventilation tubes are tiny tubes that areinserted through the eardrum to help equalize the pressure inside theear 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 eardrumor ear cyst, surgery is usually advised. This may include repairing theeardrum and removing any infected tissue, diseased or scarredmembranes, or cysts that are in or around the ear. The hearing bonesmay also need repair.

    What are the side effects of the treatments?

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

  • chronic ear drainage
  • ear cysts
  • infection
  • further hearing loss
  • The tubes last for 6 to 12months on average. Another set of tubes is needed in about 20% ofthose children.

    Surgery in and around the ear may fail to get rid of theinfection completely or fail to restore all of the hearing loss. Sideeffects 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 repairedeardrum. If synthetic materials are used to restore the bones forhearing, 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 ventilationtubes are required, drainage through the tube may continue for ashort while. After tubes are placed, some care needs to be takento prevent bacteria in the middle ear space. Sometimes chlorinatedwater, such as that in swimming pools or out of the tap, can getinto the middle ear space through the tube.

    Swimming with tubesis a controversial topic. Many doctors advise thatchildren with tubes should not swim at all. If children do swim, theyshould wear earplugs and a headband. Most doctorsadvise children with tubes not to dive. Often, antibiotic eardropsare used after swimming or if there is some concern that waterhas gotten into the ears.

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

    In most people who have had surgery for chronic middleear 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 eardrummay perforate again, or fluid may develop behind it.

    How is the condition monitored?

    Hearing loss after an upper respiratory infection or atreated acute ear infection should prompt a visit to the doctor.After tube placement, if drainage continues or hearing doesnot improve, a doctor should be consulted.

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

    Article type: xmedgeneral