Children's Hospital Colorado

Chronic Otitis Media

What is chronic otitis media?

Chronic otitis media is a group of symptoms that result from long-term damage to the middle ear. These symptoms are typically caused by recurring ear infections or problems with the eustachian tube, and often both. The eustachian tube connects the middle ear to the upper throat and back of the nasal cavity.

What causes chronic otitis media in kids?

The primary causes of chronic otitis media include:

  • Middle ear infections and/or blockage of the eustachian tube, which are the most common causes
  • Blast injuries, such as loud noises damaging the inner ear, or other injuries to the ear
  • Flare ups after infections of the nose and throat, colds or water entering the middle ear

Who gets chronic otitis media?

Anyone can get chronic otitis media; however, certain childhood syndromes and craniofacial anomalies, such as cleft palate, increase the risk for chronic otitis media. Learn more about craniofacial anomalies we treat.

In general, children are more likely to get chronic otitis media due to the anatomy of their eustachian tube, their less mature immune system and frequent exposure to germs that can cause inflammation in and around their eustachian tube.

What are the chronic otitis media symptoms?

Symptoms of chronic otitis media in kids may include:

  • Fluid in the middle ear (known as chronic otitis media effusion), which can cause infection, hearing loss, balance problems, discomfort and a feeling of fullness in the ear.
  • A hole in the eardrum. The hole can be as small as a pinpoint or as large as the entire eardrum. Smaller holes are less likely to cause hearing loss.
  • Drainage from the ear
  • Balance problems

How is chronic otitis media diagnosed?

Your child's care team will choose the best tests to identify chronic otitis media in your child by reviewing their symptoms and history. Pediatric specialists tailor all our diagnostic tests to your child's needs so they experience minimal or no discomfort. Diagnosis may include:

  • Physical exam of the ear canal and ear drum
  • Tympanogram, which takes three minutes and is performed by an audiologist to assess how easily the ear drum moves. The audiologist will place a small probe in your child's ear and make slight changes in pressure to assess parts of the ear and eustachian tube.
  • Audiogram, which is a hearing test performed by an audiologist that takes 10 to 20 minutes.
  • Auditory brainstem response, which is a hearing test done in non-sedated infants under 6 months old and under sedation in patients older than 6 months. Our specialists place electrodes on your child's head and measure brain wave responses to sounds.
  • CT scan to clearly examine the bones of the ear
  • MRI to examine the soft tissue of ear

What to expect from a chronic otitis media test

Your child's clinical visit will take about an hour. This will include checking vital signs, seeing a nurse and seeing one of our providers for history and physical examination. Your child will most likely also have an audiogram and tympanogram during this time. Depending on what these initial tests show, our pediatric specialists may recommend further testing or treatment at that time.

Chronic otitis media treatment

Chronic otitis media treatment is different for each patient and family depending on which chronic otitis media symptoms your child is experiencing. Our care team will work with you to determine the best treatment. We'll keep you informed about each step throughout this process.

Tympanostomy tubes

If your child is experiencing fluid drainage from their ear and hearing loss, we may consider tympanostomy tubes. These are small plastic or metal tubes that we surgically place into an incision in the ear drum to help drain fluid from the middle ear and prevent infection. They are usually temporary, but we may recommend them for longer if your child is still experiencing symptoms.

Multi-step treatment

If your child has a hole in their eardrum and chronic drainage, we often recommend a multi-step treatment plan. We will first clean the ear through suctioning and analyze the infected fluid. Typically, antibiotic drops treat the infection, but oral or intravenous antibiotics may be necessary if the drops are not effective.

Surgical treatment

Once the infection is controlled, we will assess repairing the hole in the ear drum. Our surgeons typically repair the ear drum by grafting the appropriate material, which can range from absorbable gelatin to nearby muscle or cartilage. Our team is experienced in these procedures and will help you make the best choice for your child. Repairing the hole in the eardrum often, but not always, improves hearing.

In complicated cases, a retraction, when the ear drum gets stuck in the middle ear, or a cholesteatoma, an abnormal skin growth in the middle ear, could develop. If untreated, these conditions could lead to serious complications. In these cases, your provider may recommend surgery.

Why choose Children's Colorado for the diagnosis and treatment of chronic otitis media?

Treating ear conditions in children is different than treating ear conditions in adults. Our pediatric otolaryngologists and audiologists have completed extra training and have advanced experience caring for kids with chronic diseases of the ear.

The tests and procedures are also performed by our care providers who have extra training and experience in caring for children. Our providers take the important first step in an accurate and complete treatment plan for every patient.

This means your child will have a more accurate diagnosis and treatment – as well as a better overall experience.

We understand that chronic otitis media can be an uncomfortable and recurring problem. We specialize in bringing relief to children suffering from ear conditions. We also work collaboratively with pediatric specialists – such as audiologists, anesthesiologists, CT/MRI technicians and radiologists – to make sure that you have the best, most complete care while seeing many of our specialists in one visit.


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