What is a chronic ear infection?

When an ear infection doesn’t go away or keeps coming back, it’s called a chronic ear infection. It usually involves a hole in the eardrum, the tissue that separates the outer and middle ears, and does not heal.

There are three common types of ear infections, but the one that affects the middle ear, called otitis media, is the most common. The middle ear is the space behind the eardrum. If the Eustachian tube, which drains fluid from the middle ear, is blocked, it can become infected. The buildup can put pressure on the eardrum, which can cause ear pain.

What is a chronic ear infection?

Chronic ear infections can be caused by acute ear infections that do not go away completely or recurring ear infections. Acute otitis media is one of the most common types of ear infections. It can become chronic. Otitis media with accumulation of fluid (fluid), which usually occurs in children, can also become chronic.

Otitis media with effusion can occur after the infection clears but fluid remains in the middle ear. When it becomes chronic, it is called chronic otitis media with effusion (COME).

Acute otitis media can also lead to chronic suppurative otitis media (CSOM), in which ear discharge does not go away or keeps recurring. CSOM is considered a complication of middle ear infection. The secretions in the CSOM continue to leak through the holes in the tympanic membrane.


Although ear infections are very common, they tend to heal quickly. To be considered chronic, symptoms must last for at least three months.

The problem with chronic ear infections is that they don’t always have the same symptoms as acute ear infections, or the symptoms are much milder. As a result, many people are unaware that they have a chronic ear infection. Symptoms of a chronic ear infection may include:

  • mild ear pain or discomfort
  • pressure in the ear
  • low-grade fever
  • Pus coming out of the ear
  • hearing loss

If a young child or infant has a chronic ear infection, they may experience the following signs of discomfort:

  • learning difficulties
  • pulling or pulling on the ear
  • irritability
  • voice delay
  • Difficulty feeding or eating


The diagnostic process usually involves various tests to examine the eardrum in more detail. Your primary care doctor will examine the affected ear using an otoscope, a small medical device that shines light into the ear and helps the doctor see the ear canal and eardrum. They will look for:

  • redness
  • bubble
  • thick liquid buildup
  • The eardrum that sticks to the bones of the middle ear
  • fluid from the middle ear
  • There is a hole in the eardrum
  • Bulge or collapse of the eardrum (when the eardrum is pulled inward)

Cultures may also be required to see if the infection is caused by bacteria, viruses, or fungi. A CT (computed tomography) scan may be required to investigate whether the infection has spread and if there is any damage to other parts of the head. Hearing tests can also be done if hearing loss is one of the symptoms.

when to see a doctor

After treating an ear infection, you should watch for any recurrence of symptoms, no matter how mild, and whether the infection doesn’t seem to go away. If symptoms recur or persist, you should see your doctor.


Treatment for a chronic ear infection depends on what’s causing it. For example, antibiotics are prescribed if bacteria are the culprit. If the cause is a hole in the eardrum, surgery may be required.


Antibiotics are the first-line treatment for chronic ear infections caused by bacteria. If the infection is caused by a fungus, topical antifungal medication will be prescribed. Antibiotics are available as capsules or ear drops.

Liquid antibiotics may be prescribed for children with chronic bacterial ear infections. The most commonly used antibiotics are amoxicillin or penicillin. Some research suggests that ear drops containing antibiotics and corticosteroids can reduce inflammation and are very effective in treating chronic ear infections.

Ear drops are usually the first-line treatment for a perforated eardrum. These ear drops may contain antibiotics.

Your child may not need antibiotics for ear infection

Surgery and expert-driven procedures

Surgery may be required if the eardrum or the ossicles of the middle ear are damaged. The surgery to repair the hole in the eardrum is called a tympanoplasty.

A mastoidectomy may be done if the infection has spread to the mastoid bone located behind the ear. Because the mastoid bone contains small air pockets, infection can spread into these pockets and cause the bone to break down. A mastoidectomy removes infected material from these spaces.

If your chronic ear infection is caused by repeated infections of the nose, mouth, or throat, an adenoidectomy may be necessary. This procedure removes the adenoids, the glands above the roof of the mouth, at the back of the nose, that fight infection. When these adenoids become inflamed, they can cause fluid to build up in the ear. Research suggests that adenoidectomy may be the best way to treat chronic ear infections in children.

Ear tube surgery is another treatment option commonly used in children with chronic ear infections. Surgery involves placing a tube in the eardrum to restore airflow. The increased airflow balances the pressure on both sides of the eardrum so fluid can drain properly from the ear.

Can adults with chronic ear infections use ear tubes?

Although this procedure is usually performed in children, adults with chronic ear infections can have ear tube surgery if the infection is caused by a persistent fluid buildup behind the eardrum.


If left untreated, chronic ear infections can lead to complications, including:

  • Mastoiditis (bacterial infection of the mastoid bone)
  • Fistulas (abnormal connections between two body parts, including those inside the ears)
  • Weakness or paralysis of the facial muscles, called facial paralysis
  • Infection of the inner ear (otitis media)
  • swelling of the membranes around the brain and spinal cord, called meningitis
  • Brain abscess (swelling filled with pus)
  • Inflammation of the sinus lining that can lead to blood clots
  • hearing loss
  • A cyst (fluid-filled sac) in the middle ear, called a cholesteatoma
  • Middle ear tissue sclerosis
  • Continuous drainage from the tympanic hole

How to prevent ear, nose and throat problems from happening to you


A chronic ear infection is an infection that doesn’t go away or keeps coming back. It usually involves a hole in the eardrum that doesn’t heal, as well as fluid buildup and swelling in the middle ear. It can be caused by an acute ear infection or repeated ear infections that don’t go away completely. Symptoms may include ear pain, fever, pus discharge from the ear, and hearing loss.

VigorTip words

Chronic ear infections can be difficult to deal with, especially if you’ve tried multiple treatment options and haven’t found relief. The good news is that once you find the right treatment, you will be able to clear the infection and prevent any further complications or permanent damage.

If you are at risk for a chronic ear infection or have recently had an ear infection, the best thing you can do is pay close attention to any symptoms. If symptoms persist or worsen, or if the infection recurs, get medical attention right away. To help prevent ear infections, clean your ears properly with a cloth and wash your hands regularly to avoid contact with bacteria, fungi, or viruses that can lead to infection.

Frequently Asked Questions

  • Why do my ear infections keep coming back?

    There is no one reason why ear infections keep coming back. Some common causes of recurring ear infections include allergies, chronic sinus infections, blocked Eustachian tubes, and frequent infections of the nose, mouth, or throat.

  • How do you treat chronic ear infections?

    Treatment options vary depending on the cause of the chronic ear infection. In many cases, ear drops containing antibiotics will be used if the cause is bacteria. If the cause is a hole in the eardrum, surgery such as myringoplasty may be needed to repair the damage.

  • Could an ear infection be a more serious sign?

    Although ear infections are usually not a sign of an underlying medical condition, they may indicate the presence of another infection or structural damage to the ear tube. If you develop any signs of an ear infection, you should see your doctor as soon as possible. Getting treatment early will help prevent permanent damage to your ears or other health complications.

  • Can chronic ear infections cause permanent damage?

    Chronic ear infections can cause permanent damage if left untreated. The infection may spread to other parts of the head or cause the eardrum to rupture. Sometimes, permanent hearing loss can occur if chronic ear infections are left untreated for a long period of time.