What is chronic otitis media?
When inflammation of the middle ear persists beyond three months and becomes established, it is called chronic otitis media. In most cases there is a non-healing hole (perforation) in the eardrum, and the disease shows itself with recurrent ear discharge and hearing loss. Previous acute infections, untreated middle-ear fluid and Eustachian tube dysfunction are the main predisposing factors.
Symptoms
The most common complaints are intermittent or continuous ear discharge, reduced hearing and a feeling of fullness. Pain is usually not prominent. Flare-ups of discharge after water gets into the ear are typical — which is why many patients have to avoid pools and the sea.
Cholesteatoma: a special situation
In one form of chronic middle-ear disease, skin tissue grows into the middle ear and forms a mass called a cholesteatoma, which erodes the surrounding bone as it advances. It presents with persistent foul-smelling discharge and progressive hearing loss. Left untreated it can damage neighbouring structures such as the balance organ, the facial nerve and the inner ear, so treatment of cholesteatoma is surgical and should not be delayed once it is found.
Diagnosis
Diagnosis is made by examining the eardrum under the microscope/endoscope, with hearing tests and, where necessary, a temporal bone CT scan. During discharging periods, ear drops are used to dry the ear — but as long as the perforation persists, infections tend to recur.
Surgical treatment: tympanoplasty
The lasting solution is surgery. In tympanoplasty, the hole in the eardrum is repaired with the patient's own tissue (usually cartilage membrane or muscle fascia); damaged hearing bones can be repaired in the same session. In cholesteatoma, the diseased tissue is removed (together with mastoidectomy where needed). The goals of surgery are to stop the discharge, make the ear safe, and improve hearing where possible. Recovery takes a few weeks, during which the ear must be kept dry.
This article is for general information purposes only; please consult your physician for diagnosis and treatment.