chronic otitis mediaImages (Click to view larger image)
persistent otitis media, recurrent otitis media, glue ear
Chronic otitis media is a term to describe persistent or chronic middle ear inflammation. This may be due to persistent fluid behind the eardrum from repeated middle ear infections.
What is going on in the body?
Fluid behind the eardrum is common with a middle ear infection. This fluid goes away in close to 90% of children within three months of the infection. In children with chronic middle ear inflammation with effusion, or fluid behind the eardrum, the fluid does not go away on its own.
Repeated episodes of middle ear infections may also be due to a tear in the eardrum or cysts, which are abnormal sacs, in the ear. These conditions make the ear more likely to become infected with bacteria.
What are the signs and symptoms of the condition?
In cases of middle ear inflammation with fluid behind the eardrum, the most common symptom is loss of hearing. If children are old enough, they may say that the ear feels plugged or full. Pain and fever, which occur with sudden ear infections, are not seen.
The signs of hearing loss in children may be quite hard to detect. An affected child may seem to ignore the parent, sits close to the TV, or fail to develop speech at a normal age. The hearing loss is usually mild, and its effect on speech is quite subtle. In these milder forms of hearing loss, low-power sounds, such as F, S, or TH, are the first to be pronounced poorly.
In middle ear inflammation with fluid behind the eardrum, different kinds of fluid can be present. The fluid can range from a clear or yellow liquid to a thick, white material that resembles rubber cement. Thicker fluid usually means more inflammation in the ear.
In cases of repeated middle ear infection, the eardrum may have a tear or there may be a cyst in the ear. Symptoms may include hearing loss and discharge from the ear, which can range from a watery consistency to a yellow-green, foul-smelling discharge. Other symptoms may develop if complications occur.
What are the causes and risks of the condition?
The cause of middle ear inflammation with fluid behind the eardrum is usually a sudden middle ear infection. In large studies in daycare centres, up to 70% of children had fluid behind their eardrums at some point during a year. About 90% of the time the fluid went away without treatment.
Other causes include chronic sinus infection and allergies. An increased risk of this condition may occur with certain abnormalities in the shape of the face, palate, or eustachian tube. The eustachian tube connects the middle ear cavity with the throat. Even though it is extremely rare, fluid behind just one eardrum can indicate a cancer. This is particularly true in adults.
Children with Down syndrome seem to have a higher risk of this condition.
What can be done to prevent the condition?
To prevent middle ear inflammation with fluid behind the eardrum, children should receive prompt treatment for ear infections. If antibiotics are prescribed, the pills should be taken until they are gone, even if the child feels back to normal. Children may be given special vaccines to help prevent future infections as well.
How is the condition diagnosed?
There are two main ways to diagnose chronic middle ear inflammation due to fluid behind the eardrum. The first is a physical examination, which will find fluid behind the eardrum and poor movement of the eardrum. The second way is to measure of the amount of eardrum mobility with a special test. The test is abnormal when fluid is behind the eardrum. A hearing test will often reveal some hearing loss as well.
In chronic middle ear inflammation due to a tear in the eardrum or an ear cyst, the diagnosis is usually made with a physical examination. Hearing tests are usually abnormal as well. Special x-ray tests, such as a CAT scan, may be done in some cases.
What are the long-term effects of the condition?
With prompt treatment, there usually are no long-term effects, unless treatment fails. Untreated cases or treatment failure may result in:
What are the risks to others?
- hearing loss
- speech and learning delays secondary to hearing loss
- scarring of the eardrum
- damage to the bones that assist with hearing and some of the skull bones
- damage to the nerves responsible for hearing, which can cause permanent, untreatable deafness
- extension of the infection into the skull or even the brain, which can cause death in rare cases
Unlike sudden ear infections, chronic middle ear inflammation is often not contagious and poses little risk to others.
What are the treatments for the condition?
Antibiotics and corticosteroid medications may be given in many cases. If middle ear inflammation with fluid behind the eardrum does not respond to antibiotics and oral corticosteroids, ventilation tubes are a treatment option. Ventilation tubes are tiny tubes that are inserted through the eardrum to help equalise the pressure inside the ear and allow fluid drainage.
With a perforated eardrum or ear cyst, surgery is usually advised. This may include repairing the eardrum and removing any infected tissue, diseased or scarred membranes, or cysts that are in or around the ear. The hearing bones may also need repair. Also removal of adenoids in children over two years of age is helpful.
What are the side effects of the treatments?
Ventilation tubes usually cause few side effects. A hole in the eardrum remains in 2% to 3% of children once the tubes are removed. Chronic ear drainage, ear cysts, infection and further hearing loss are other possible complications. The tubes last for 6 to 12 months on average. Another set of tubes is needed in about 20% of those children.
Surgery in and around the ear may fail to get rid of the infection completely or fail to restore all of the hearing loss. Side effects can include a disturbance of taste on part of the tongue. Other side effects may include nerve damage leading to deafness, dizziness, facial paralysis on one side, or breakdown of the repaired eardrum. If synthetic materials are used to restore the bones for hearing, the materials can become dislodged or fail.
What happens after treatment for the condition?
In middle ear inflammation with fluid behind the eardrum, hearing is usually restored very quickly after treatment. If ventilation tubes are required, drainage through the tube may continue for a short while. After tubes are placed, some care needs to be taken to prevent bacteria in the middle ear space. Sometimes chlorinated water, such as that in swimming pools or out of the tap, can get into the middle ear space through the tube. Swimming with tubes is a very controversial topic. Many doctors advise that children with tubes should not swim at all. If children do swim, they should wear earplugs and a headband. Most doctors advise children with tubes not to dive. Often, antibiotic eardrops are used after a child swims or if there is some concern that they have got water into his or her ears.
The risk of an infection is highest if shampoo or soapy bath water enters the middle ear through the tube. Bath water often contains bacteria from the bowel and skin. This water more readily enters the middle ear because of the soap.
In most people who have had surgery for chronic middle ear inflammation, healing is complete within two to three months. If treatment has been successful, there will be no further infections, and hearing is improved. But if the infection continues, the eardrum will perforate again or fluid will develop behind it.
How is the condition monitored?
Hearing loss after an upper respiratory infection or a treated acute ear infection should prompt a visit to the doctor. After tube placement, if drainage continues or hearing does not improve, a doctor should be consulted. Anyone with ear drainage needs to be seen by a doctor right away. This is especially true if there is hearing loss, dizziness, facial paralysis or high fevers.
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request