Chronic Ear Infection
Treatment of recurrent or persistent middle-ear or outer-ear infections
What is chronic ear infection?
The middle ear is an air-filled space that has to be ventilated to work. A narrow tube runs from it to the back of the nose and opens each time you swallow, equalising pressure and letting the lining stay dry. When that tube fails repeatedly, or an infection breaches the drum, the space stops being sterile and the lining changes character. It thickens, produces mucus and becomes easy to reinfect.
Chronic disease is defined by how long this has gone on, not how severe any one episode is. Once the lining has been inflamed for months, ordinary colds and any water reaching it start new episodes, and the ear settles into a pattern of quiet spells broken by wet ones.
Two forms behave very differently. In one the disease sits in the mucosal lining and the trouble is recurrent infection. In the other, skin migrates into the middle ear and forms a sac that expands and erodes what it touches. The second is the reason every long-standing ear gets examined properly instead of simply treated with drops.
What you might notice
- Discharge from the ear
- A child who does not respond when spoken to
- Difficulty following conversation
- Ear pain
How it is diagnosed
Examination under a microscope is the core of it. The doctor cleans the canal, looks at every part of the drum including the top edge, which is where the more serious form starts, and notes whether the middle ear lining behind it looks dry or actively inflamed.
An audiogram measures both how much is lost and where the fault sits, distinguishing a problem in the conducting chain from one in the inner ear. A swab is sent when the ear is wet, because organisms that colonise a chronic ear do not always respond to the antibiotic a family doctor would reach for first.
A CT of the temporal bone is ordered before any surgery and whenever the top edge of the drum is retracted. It shows the mastoid air cells, the state of the bony chain and whether anything has been eroded near the facial nerve or the inner ear.
Recovery
Getting the ear dry is the first phase and it takes weeks, with regular cleaning under the microscope and drops used exactly as prescribed. Water precautions are not optional during this time; one shower with an open ear undoes a fortnight.
After surgery the ear is packed and sounds muffled for four to six weeks. There may be a small cut behind the ear that is sore for a few days and a dressing for the first night. Taste can be altered on one side of the tongue for some weeks because a nerve carrying taste runs across the middle ear.
Reviews continue at intervals for at least a year, since the point of the operation is a permanently dry ear and that can only be judged over time. Hearing is retested at three months and again at a year.
If it is left untreated
An ear that discharges on and off for years does not stay in the same place. Each episode adds scarring, and the chain of bones that carries sound gradually stiffens or erodes, so the loss becomes permanent and no longer improves when the discharge settles.
Where skin has migrated into the middle ear, waiting is not safe. That sac grows steadily and dissolves the bone around it, and what it reaches determines the complication: the balance organ, the facial nerve as it passes through, or the bony plate separating the ear from the brain. These are uncommon now, but they are the reason this form is treated on diagnosis instead of watched.
In children, an ear that is wet for long periods interrupts hearing during the years speech is being built, and that effect shows up in the classroom before it shows up as a complaint.
Questions about chronic ear infection
Why do the drops stop working after a while?
Drops treat the infection sitting in the middle ear, and they often work well for it. What they cannot do is change the reason the ear keeps getting infected, which is a lining that has been inflamed for a long time and an opening through which water and bacteria can reach it. Once the drops stop, the ear is as exposed as it was before. Organisms in a chronic ear are also different from those in a short-lived infection and some become resistant to repeated courses, so a swab is taken instead of another course being given blindly.
Is this the kind of ear infection that can be dangerous?
Most chronic ear disease is a nuisance more than a danger, causing repeated discharge and gradual hearing loss. There is a second form, where skin migrates into the middle ear and forms a sac that slowly erodes the bone around it, and that one is treated when it is found instead of watched. It is diagnosed by examining the upper part of the drum under a microscope and confirmed on a CT scan, and it is the reason a long-standing ear is examined properly instead of being managed on drops alone.
Does the ear have to be dry before surgery?
For a graft repair, yes, as far as it can be. A graft placed onto an actively infected lining is far less likely to take, so surgeons generally want the ear dry for a period of weeks first, achieved with cleaning under the microscope, drops guided by a swab, and strict water precautions. Where the disease is the eroding kind, that rule does not apply and surgery goes ahead regardless, since removing the disease is what makes the ear dry.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
Day CareTalk to a care coordinator about chronic ear infection
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one