İşitmeAtölyesiAt a glance
Chronic inflammation of the middle ear and mastoid; the most common form runs with a permanent eardrum perforation and discharge.
Recurrent/persistent discharge, conductive hearing loss, ear fullness; severe pain is usually absent.
Dizziness, facial palsy or severe headache are signs of complications and require emergency assessment.
Ear cleaning and topical treatment; surgery for perforation/cholesteatoma; hearing aids/bone-conduction systems for persistent loss.
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If you have recurrent or persistent discharge from your ear and declining hearing, see an ear, nose and throat physician. If dizziness, facial palsy, severe headache or fever are added, prompt emergency assessment is needed; these are rare but important signs of complications.
Definition and epidemiology
Chronic otitis media (COM) is persistent inflammation of the middle ear and mastoid cavity. Its most common form is chronic suppurative otitis media (CSOM), which runs with a permanent hole in the eardrum and intermittent discharge. A special subtype called cholesteatoma, marked by abnormal skin accumulation in the middle ear, is also evaluated under this heading.
According to the World Health Organization, CSOM is an important cause of preventable childhood hearing loss, especially in developing regions; a community prevalence above 4% is considered a priority problem (WHO, 2004).
The process usually becomes chronic through a combination of Eustachian tube dysfunction, recurrent infections and persistent changes in the middle-ear mucosa (Verhoeff et al., 2006).
Symptoms and signs
The most typical symptoms are recurrent or persistent ear discharge, conductive hearing loss and occasional ear fullness. Unlike acute otitis media, severe pain is usually absent.
A painless course can be misleading; it may mask progressive problems such as ossicular chain damage or cholesteatoma. Therefore, prolonged discharge and hearing loss must always be assessed.
Dizziness, facial palsy and severe headache are rare but important signs of complications and require emergency assessment.
Causes and risk factors
Eustachian tube dysfunction and recurrent middle-ear infections underlie it. Previous acute otitis media episodes, a persistent drum perforation and chronic inflammation of the middle-ear mucosa fuel the process.
Risk factors include frequent upper respiratory infections, passive smoke exposure, crowded living conditions, difficult access to healthcare, and craniofacial anomalies such as cleft palate.
Cholesteatoma may be congenital but usually develops as an acquired process on a background of chronic Eustachian dysfunction and drum retraction; because it is progressive and can erode surrounding bone, it is of special importance (Kuo et al., 2015).
Audiological and clinical assessment
The basis of assessment is otoscopic/microscopic examination; perforation, discharge and cholesteatoma findings can be seen directly. In suspicious cases, high-resolution CT is used to evaluate the mastoid and middle ear.
- Pure-tone audiometry: determines the degree of conductive or mixed loss.
- Tympanometry: applied on an intact drum; a large canal volume is found when there is a perforation.
- Speech discrimination tests: give information about inner-ear function and the rehabilitation plan.
- Imaging: advanced audiological and imaging tests are planned when inner-ear involvement is suspected.
Audiological data guide both surgical planning and the determination of hearing-aid candidacy.
Treatment and audiological rehabilitation
For active discharge, ear cleaning and appropriate topical (drop) treatment are applied first. With a chronic drum perforation, ossicular damage or cholesteatoma, surgery (tympanoplasty, and where needed mastoidectomy) comes onto the agenda; the decision is made by the physician.
In cholesteatoma the main aim is to remove the disease completely and prevent complications; restoring hearing is secondary and often addressed in a second stage.
In patients with persistent hearing loss despite surgery, or who are unsuitable for surgery, hearing aids can be used. If ear-canal discharge or anatomy is unsuitable for a conventional device, implantable systems that conduct sound via bone (BAHA / bone-conduction systems) are considered.
Impact on quality of life and advice
Recurrent discharge and hearing loss can affect school and working life, social communication and self-esteem. Untreated hearing loss, especially in children, can adversely affect language development.
Protecting the ear from water, treating infections early and regular follow-up are important. Post-surgical follow-up should not be neglected for early detection of recurrence.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Chronic Otitis Media. Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/kronik-otitis-media/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/kronik-otitis-media/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- Kuo, C. L., Shiao, A. S., Yung, M., et al. (2015). Updates and knowledge gaps in cholesteatoma research. BioMed Research International, 2015, 854024.
- Mittal, R., Lisi, C. V., Gerring, R., et al. (2015). Current concepts in the pathogenesis and treatment of chronic suppurative otitis media. Journal of Medical Microbiology, 64(10), 1103-1116.
- Verhoeff, M., van der Veen, E. L., Rovers, M. M., Sanders, E. A., & Schilder, A. G. (2006). Chronic suppurative otitis media: A review. International Journal of Pediatric Otorhinolaryngology, 70(1), 1-12.
- World Health Organization. (2004). Chronic suppurative otitis media: Burden of illness and management options. WHO.
Frequently asked questions
I have constant discharge from my ear; is it dangerous?
Long-standing ear discharge may be a sign of chronic inflammation in the middle ear and should always be assessed by an ENT physician. Most cases are controlled with appropriate treatment; however, if neglected, hearing loss and rarely serious complications can develop.
Will the hole in my eardrum close on its own?
Small holes may sometimes heal on their own, but large, chronic holes usually require surgical repair (tympanoplasty). The state of the hole and its effect on hearing become clear with your physician’s examination.
Is cholesteatoma cancer?
No, cholesteatoma is not cancer. However, it is a skin accumulation that can grow in the middle ear and damage the surrounding bone. Because of its progressive nature it should not be neglected and usually needs to be removed surgically.
Will surgery restore my hearing?
The main aim of some operations is to remove the disease and make the ear safe; improving hearing depends on the state of the ossicles and is sometimes done in a second stage. It is important to clarify your expectations with your physician before surgery.
What happens if water gets into my ear?
In people with a drum perforation, water reaching the middle ear can trigger infection. Using the protective methods your physician recommends during bathing and swimming reduces discharge episodes.
Scales that can be used to monitor the impact of hearing loss on daily life and, in children, development: