Chronic Ear Infections


Causes, Incidents and Risk Factors

Chronic ear infections, also called chronic otitis media is an inflammation or infection of the middle ear that lasts more than 3 months.

Inflammation or infection of the middle ear occurs when the eustachian tube to that ear is chronically obstructed. The eustachian tube is the tube that connects 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 of time). This most commonly occurs due to a narrow Eustachian tube that people are born with. This condition tends to be genetic. Other problems such as acid reflux, nasal allergies, multiple infections, temporal bone fractures, or swelling of the adenoids can contribute to them. Bacteria from the back of the nose (nasopharynx) that live in the adenoid tissue usually, will travel 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. The ear infection can cause drainage from the ear which comes from behind the ear drum through the hole of the ear drum and into the ear canal. A chronic ear infection can cause granulation tissue (inflammatory tissue in the space behind the ear drum). This tissue can be destructive to the structures

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.

Chronic Ear Infection Symptoms

  • Pus-like drainage from the ear
  • Hearing loss
  • Pain and pressure in the ear is uncommon but pressure can occur if there is active infection

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 if there is active infection or retract inward. A CT scan of the ear bones may show involvement of the infection beyond the middle ear into the mastoid bone which is located behind the ear.


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

Treatment of chronic otitis media (ear infections) that has caused a hole in the ear drum involves closure of the hole and removal of the infection. At UC Irvine, we take a graduated approach in treating perforations in the ear drum.

More than half of the patients with perforations can be treated in the office without the need for general anesthesia. The UC Irvine team uses office patch procedures, serum paper myringoplasty, and tissue myringoplasty and office tympanoplasty. If a patient has chronic drainage, then a more extensive procedure in the operating room (tympanoplasty with mastoidectomy) is performed. A tympanoplasty and mastoidectomy involves using tissue from the muscle behind the ear to repair the hole in the ear drum. In addition, a mastoidectomy is performed to remove chronic infections in the mastoid. The chance of success of this procedure in our experience is approximately 95%.