Chronic otitis media: when ear inflammation does not settle

What is chronic otitis media?

The middle ear is the air-filled chamber just behind the eardrum that houses the three hearing bones. Chronic otitis media is inflammation of that chamber sustained over months — usually accompanied by a perforation of the eardrum that has not healed.

For as long as the perforation exists, the middle ear is exposed. Water, dust and bacteria reach a place they should never reach, and inflammation starts again. This is why chronic otitis tends to follow a pattern of improvement and relapse, without ever fully resolving.

What are the symptoms?

• Discharge from the ear, intermittently, sometimes with a strong odour.
• Hearing loss that increases slowly, over years.
• A blocked or muffled sensation on the affected side.
• Tinnitus in the affected ear.
• Little or no pain, in most cases.

Signs that warrant prompt assessment: intense pain, spinning vertigo, fever, persistent headache or weakness on one side of the face.

Is chronic otitis the same as recurrent otitis?

No, and the confusion is common.

What to compare	Recurrent otitis	Chronic otitis media
What happens	Several separate acute episodes, with recovery in between	Inflammation that does not settle
Who typically has it	Mainly young children	Adolescents and adults, with a long history
Pain	Severe, in flare-ups	Little or none
Eardrum	Intact between episodes	Usually perforated
Basis of treatment	Address the causes of recurrence	Leave the ear dry and safe

What are the risks of leaving it untreated?

Chronic otitis is not merely a nuisance. Inflammation sustained over years — and above all cholesteatoma, which grows and erodes whatever it meets — can reach important structures around the middle ear:

• The hearing ossicles. Malleus, incus and stapes transmit sound from the eardrum to the inner ear. When they are eroded, conductive hearing loss follows, usually permanent without surgical reconstruction.
• The labyrinth. The inner ear structure responsible for balance. Erosion of its bony wall, known as a labyrinthine fistula, causes spinning vertigo and can lead to sensorineural hearing loss, which surgery does not recover.
• The facial nerve. It runs through the bone alongside the middle ear. Involvement of this nerve causes weakness or paralysis of one side of the face.
• Structures adjacent to the skull. Rare but serious complications such as meningitis, abscess and venous sinus thrombosis, described when disease extends beyond the temporal bone.

None of this happens overnight, and most people with chronic otitis never reach that point. What this list explains is why an ear that has been discharging for years deserves assessment even without pain: the earlier a cholesteatoma is identified, the smaller its reach.

Seek assessment without delay if spinning vertigo, intense pain, fever, persistent headache or facial weakness appear.

How is the diagnosis made at Clínica Rhinus?

The consultation begins with the history — how long, how often it discharges, whether there has been previous surgery, whether hearing loss is noticed — and with otoscopy. From there, the tests that usually follow:

• Audiometry and tympanometry, to measure the degree and type of hearing loss and assess eardrum behaviour.
• CT of the temporal bones, when the bone and middle ear structures need to be seen in detail, particularly where cholesteatoma is suspected.

What are the treatments?

Medical treatment addresses the inflammatory phase: cleaning the canal, topical medication and advice on keeping the ear dry. It controls infection, but it does not close the perforation.

Surgical treatment comes in when the aim is to close the eardrum, remove middle ear disease or treat a cholesteatoma. The most common procedures are tympanoplasty — reconstruction of the eardrum — and tympanomastoidectomy, when the mastoid, the bone behind the ear, must also be cleared. That subject has its own page: ear surgery.

The choice between one path and the other depends on the size and location of the perforation, the state of the ossicles, the presence of cholesteatoma, hearing in the other ear, and the patient’s circumstances. It is a conversation, not an automatic rule.

Sources: Brazilian Society of Otology · Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Tratado de Implante Coclear e Próteses Auditivas Implantáveis. 2nd ed. Thieme Revinter. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.