Chronic middle ear disease

Chronic middle ear disease refers to a condition of the middle part of the ear that doesn’t go away or that keeps coming back. It can result in permanent damage to the ear, and often involves a perforated eardrum.

Most acute middle ear infections (such as otitis media) clear up on their own within a few days and don't require any specific treatment.

However chronic middle ear disease doesn’t go away, or keeps recurring. If the disease causes an infection, fluid or swelling behind the eardrum it can result in long-term or permanent damage to the ear. It frequently involves a hole in the eardrum (perforated eardrum) that doesn’t heal.

There are a number of specific conditions under the general heading of chronic middle ear disease, each with a range of causes.

Otitis media is a group of viral and bacterial inflammatory diseases of the middle ear. Acute otitis is a rapidly developing infection and usually presents with ear pain whilst otitis media with effusion is when fluid is present.

Cholesteatoma (a type of skin cyst in the middle ear) can be the result of a birth defect (congenital) or, more commonly, it is caused by a chronic ear infection. The cyst may become infected or enlarge, which may affect hearing, balance, and sometimes the way your facial muscles work.

Mastoiditis is an infection of the mastoid bone in the inner ear, usually caused by an infection of the middle ear spreading into the surrounding bone (the mastoid process).

Chronic Suppurative Otitis Media (CSOM), a disease of the middle ear, is an ongoing cycle of infection causing inflammation, ulceration, and granulation. This may result in damage of the surrounding structures.

The exact cause of eosinophilic otitis media is unknown, but it is thought to be associated with bronchial asthma and nasal allergy. It can sometimes lead to hearing loss.

A chronic middle ear disease can cause milder symptoms than an acute condition. Symptoms including pain, pressure or fluid in the ear may affect one or both ears and may be constant or come and go.

A range of symptoms may be present depending on the exact condition. These include fever and a persistent, throbbing pain around and within the ear. There may be a minor or profuse discharge of fluid from the ear - this may be fluid, pus or a bloody discharge. Hearing may be impaired and this may well get suddenly worse or progressively worse as the condition progresses. Some patients will experience a fever and perhaps dizziness or balance impairment.

We recommend that you contact your doctor as soon as possible if you are experiencing any of these symptoms, or if you suspect your eardrum may be perforated.

Symptoms of a chronic middle ear disease may include:

  • mild ear pain
  • pressure in the ear
  • fluid build-up, or fluid draining from the affected ear
  • fever
  • hearing loss
  • impaired balance
  • confusion or sleepiness
  • facial weakness
  • difficulty sleeping

Your doctor will initially assess your condition and may need to refer you to a specialist for additional tests and diagnosis.

A visual examination will be required using a medical device (otoscope or auriscope) to look into your ears. If you have a discharge from your ears a sample may be taken for testing and diagnosis.

Further tests may also be required. For example, if cholesteatoma is suspected, computed tomography (a CT scan) or magnetic resonance imaging (an MRI scan) may be suggested.

CT scan

CT stands for ‘computerised tomography’. A CT scan is a detailed X-ray used to create detailed images of the inside of your body.   

MRI scan

MRI (magnetic resonance imaging) is a special technique that uses powerful magnets, radio waves and computers to produce detailed images (or scans) of the inside of your body.

Chronic middle ear disease

There are a range of treatment options for chronic middle ear diseases depending on the underlying cause, the severity of the symptoms, and the age of the patient.

What next?

If you are suffering with a suspected condition, you should seek the advice of your doctor who will be able to refer you to Benenden Hospital for diagnosis and treatment.

There are four ways to access treatment at Benenden Hospital which include self-funding, using private medical insurance or your Benenden membership, or through the NHS e-Referral scheme.