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 throat to the middle ear. 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.

When the middle ear is actually infected with bacteria (or occasionally, viruses) rather than just inflamed, it is more serious. 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 infections.

• Ear pain or discomfort, earache
  • Usually mild
  • May feel like pressure in the ear
• Pus-like drainage from the ear
• Hearing loss

Treatment is focused on relief of symptoms and cure of the infection.

Antibiotics may be prescribed if the infection appears bacterial. Antibiotic treatment is usually long-term and may be oral or in the form of antibiotic ear drops if there is a hole in the eardrum.

Surgical removal of the adenoids may be necessary to allow the eustachian tube to open. A surgical opening may be made in the eardrum (myringotomy) to allow fluid to drain. This may or may not include placement of drainage tubes in the ear. Surgical repair of a ruptured eardrum may prevent further chronic ear infections.

Keep the ears clean and dry to prevent reinfection. This is particularly important if myringotomy has been performed.

• Permanent damage to the ear with partial or complete deafness
• Mastoiditis
• Cholesteatoma (middle ear cyst)
• Epidural abscess (inflammation around the brain)
• Facial paralysis

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 8-12 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.