The Eustachian tube runs from the middle of each ear to the back of the throat. This tube drains fluid made in the middle ear. If the Eustachian tube becomes blocked, fluid can build up. When this happens, infection can occur. A chronic ear infection develops when fluid or an infection behind the eardrum does not go away.
"Suppurative chronic otitis" is a phrase health care providers use to describe an eardrum that keeps rupturing, draining, or swelling in the middle ear or mastoid area and does not go away.
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.
Symptoms of a chronic ear infection may be less severe than symptoms of an acute infection. The problem may go unnoticed and untreated for a long time.
Symptoms may include:
Ear pain or discomfort that is usually mild and feels like pressure in the ear
Symptoms may continue or come and go. They may occur in one or both ears.
Exams and Tests
The health care provider will examine the ears. This may reveal:
Dullness, redness in the middle ear
Air bubbles in the middle ear
Thick fluid in the middle ear
Eardrum that sticks to the bones in the middle ear
Draining fluid from the eardrum
A hole (perforation) in the eardrum
An eardrum that bulges out or pulls back inward (collapses)
Tests may include:
Cultures of the fluid may show bacteria, and these bacteria may be harder to treat than the bacteria commonly involved in an acute ear infection.
A CT scan of the head or mastoids may show that the infection has spread beyond the middle ear.
Hearing tests may be needed.
The provider may prescribe antibiotics if the infection is caused by bacteria. These medicines may need to be taken for a long time. They can be given by mouth or into a vein (intravenously).
If there is a hole in the eardrum, antibiotic ear drops are used. The provider may recommend using a mild acidic solution (such as vinegar and water) for a hard-to-treat infected ear that has a hole (perforation). A surgeon may need to clean out (debride) tissue that has gathered inside the ear.
Other surgeries that may be needed include:
Surgery to clean the infection out of the mastoid bone (mastoidectomy)
Surgery to repair or replace the small bones in the middle ear
Damage to the part of the ear that helps with balance
Hearing loss from damage to the middle ear may slow language and speech development. This is more likely if both ears are affected.
Permanent hearing loss is rare, but the risk increases with the number and length of infections.
When to Contact a Medical Professional
Call your health care provider if:
You or your child has signs of a chronic ear infection
An ear infection does not respond to treatment
New symptoms develop during or after treatment
Getting prompt treatment for an acute ear infection may reduce the risk of developing a chronic ear infection. Have a follow-up exam with your provider after an ear infection has been treated to make sure that it is completely cured.
Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngol Head Neck Surg. 2013 Jul;149(1 Suppl):S1-35.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.