Chronic ear infections, also called chronic
otitis media is an inflammation or infection of the middle ear. Chronic means
recurring or persistent.
Causes, incidence, and risk factors
Inflammation or infection of the middle ear
occurs when the eustachian tube to that ear is blocked. The eustachian tube is
the passage from the back of the nose to the space behind the ear drum. Chronic
otitis media occurs when the eustachian tube becomes blocked repeatedly (or
remains blocked for long periods) due to allergies, multiple infections, ear
trauma, or swelling of the adenoids. Bacteria from the back of the nose (nasopharynx)
will go through the eustachian tube and cause an infection in the space behind
the ear drum (middle ear).
When the middle ear is acutely infected with
bacteria (or occasionally, viruses) it is called acute otitis media. A chronic
ear infection may be the result of an acute ear infection that does not clear
completely, or the result of recurrent ear
infections. The infection may spread into the mastoid bone behind the ear (mastoiditis),
or pressure from fluid build-up may rupture the eardrum or damage the bones of
the middle ear.
A chronic ear infection may be more
destructive than an acute ear infection because its effects are prolonged or
repeated, and it may cause permanent damage to the ear. However, a chronic,
long-term infection may show less severe symptoms -- so the infection may remain
unnoticed and untreated for a long time.
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
Ear pain or discomfort,
May feel like pressure in the ear
drainage from the ear
Note: Symptoms may be continuous or intermittent, and may occur in one or both
Signs and tests
An examination of the ear may show dullness, redness,
air bubbles, or fluid behind the eardrum. The eardrum may show drainage or
perforation (a hole in the eardrum). The eardrum may bulge out or retract
Cultures of drainage may show bacteria. These
bacteria may be resistant or harder to treat than the bacteria commonly involved
in acute ear infection.
A CT scan of the ear bones may show spreading
of the infection beyond the middle ear into the mastoid bone (bone behind the
Treatment is focused on relief of symptoms and
cure of the infection.
Oftentimes, children with otitis media are
treated with antibiotics. If the child has multiple infections (generally 6
infections per year), then small tubes are placed in the ear drum to reduce the
number of subsequent infections. These tubes will stay in for about 6 months to
a year and then fall out on their own. Generally, 80% of children will only need
to have the tubes placed only once. Occasionally surgical opening may be made
in the eardrum (myringotomy)
to allow fluid to drain without placing tubes.
Generally ear tube placement is considered
when there is:
infections in one year
Hearing loss from multiple infections that has caused delay in speech
Fluid behind the ear drum that is present for 6 months in one ear or 4
months in both ears
Significant hearing loss in both ears from persistent fluid behind the ear
Most children will have temporary and minor
hearing loss during and right after an ear infection, because fluid can linger
in the ear. Although this fluid can go unnoticed, it can cause significant
hearing problems in children. Any fluid in the ear that persists longer than
12 weeks is cause for concern -- in children, hearing problems may cause
speech to develop slowly.
Permanent hearing loss is rare, but the risk
increases the more infections a child has.
The tubes fall out on their own in 6-12
months. The tubes have to replaced in 20% of children because of continued
Surgical removal of the adenoids may be
necessary to take away the source of the bacteria which cause ear infections if
the tubes have to be replaced.
Click below for a surgical video of a tube
placement performed by Dr. Djalilian. Please note that this is a
surgical video and may not be appropriate for some viewers.
If a hole in the ear drum is present (as a
result of infections or trauma) it can be repaired surgically. Surgical repair of a ruptured
eardrum may prevent further chronic ear infections. Removal of the infection
from the mastoid bone (bone behind the ear) may be necessary (called a
mastoidectomy) in conjunction with the repair of the ear drum. The success rate
of the repair of the ear drum is approximately 90%.
Click below (under mastoidectomy section) for a surgical video of a
At UC Irvine our ear surgeon (Dr. Djalilian) specializes in
the treatment of ear drum perforations that failed treatment after a
tympanoplasty operation. He performs ~4-6 of tympanoplasty with or without
mastoidectomies a week at UC Irvine Medical Center.
A mastoidectomy (removal of infection from the
mastoid bone) in combination with tympanoplasty (repair of the ear drum) is
often required in the treatment of chronic ear infections in teenagers and
adults. It has been found that the reason these infections keep recurring is
because bacteria form a compound around them that protects them from
antibiotics. This form of bacteria, called biofilm, will intermittently get
activated and cause an infection with drainage from the ear. In order to stop
the infections, the infection, which often settles in the bone behind the ear,
has to be removed.
The surgery to remove the infection and repair
the ear drum is very delicate and performed under the microscope.
Removal of part of the mastoid bone
(mastoidectomy) will not cause a visible defect since the coverings of the bone
are closed over it to prevent the appearance of a depression behind the ear.
Click below for a video of a tympanoplasty
with mastoidectomy performed by Dr. Djalilian. Please note that this is a
surgical video and may not be appropriate for some viewers.
Chronic otitis usually responds to treatment,
but treatment may be prolonged (over several years). The disorder is usually not
a threat to life but may be uncomfortable and may result in serious
complications if left untreated.
Complications of Chronic Ear Infections
Permanent damage to the ear with partial or complete deafness
Meningitis and Epidural abscess (inflammation and infection around the brain)
New Innovations in the Treatment of Chronic Otitis Media
Otoendoscopy (small angled cameras) allows the surgeon to remove disease from
areas that cannot be seen with a microscope. The combination of microscopes and
endoscopy helps to create the least invasive treatment for patients with chronic
ear infections. At UC Irvine, otoendoscopy (in addition to a microscope) is used
routinely used in chronic ear infection surgery for a less invasive approach.
This reduces the likelihood of second surgeries.
Use of post-surgical scar tissue for the repair of tympanic membrane
perforations. Patients who have had a previous surgery for repair of their ear
drum perforation will often not have any fascia (muscle covering) left for the
repair. Some surgeons use incisions behind the opposite ear or create a long
incision behind and above the ear to get more fascia. In a recently published
study by Dr. Djalilian an innovative technique to use post-surgical scar tissue
that is delicately separated and used for repair of the ear drum. This tissue is
obtained from the same incision and does not require any additional incisions.
To Make an
Appointment with Dr. Djalilian, Please Call
714-456-7017 or click
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