Chronic Ear Infections

Chronic Ear Infections

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Middle ear infections are common in children and often resolve on their own or with antibiotics. However, when they occur frequently, more aggressive treatment may be recommended to ensure the infection does not damage your child’s eardrum. Duke’s pediatric otolaryngologists are specialists in treating disorders that affect the ear, nose, and throat. They identify the cause of your child’s chronic ear infections and recommend effective treatment to clear the infection, restore temporarily lost hearing, and prevent future illness.

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What Causes Chronic Ear Infections

Children may experience frequent ear infections because the insides of their ears are not fully developed. Normally, a child’s Eustachian tubes -- which run from the middle ear to the back of the throat -- drain secretions from the middle ear and serve to keep the pressure behind the ear drum (middle ear) equal to that of the outer ear. Young children have short, straight Eustachian tubes, which can prevent proper pressure equalization. Swelling or inflammation from a cold or allergy can also block the tubes and cause a buildup of fluid in the middle ear. This fluid can become infected with bacteria or a virus.

Untreated chronic ear infections can lead to several complications, including:

In severe cases, a skin cyst (cholesteatoma) may develop in the middle ear. The cyst can cause problems with hearing and excessive ear drainage.

Tympanic Membrane Perforation
The eardrum may tear from repeated infections. The hole sometimes closes on its own but may need surgical repair if it does not.

Hearing Loss
While hearing loss associated with chronic ear infections is rarely permanent, it can occur when an untreated infection results in damage to the eardrum, the bones of the ear, or the hearing nerve.

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When necessary, our ENT doctors will work with other pediatric specialists to provide the most appropriate treatment. These specialists may include audiologists, speech pathologists, infectious disease specialists, and allergists.

Ongoing Monitoring

In some cases, doctors will keep a close eye on your child if he or she is experiencing repeated ear infections. The doctor will watch for signs of hearing loss and other complications.


Oral antibiotics are typically prescribed to clear the ear infection. Medicines to reduce pain (taken orally or as ear drops) may also be recommended.

Ear Tubes

Tiny metal or plastic tubes may be inserted into your child’s ears during outpatient surgery to help prevent future ear infections. Ear tubes help prevent fluid from backing up and getting infected, and allow infections to drain out of the ear. They also allow air into the ear and help regulate air pressure. These tubes fall out on their own as children grow. 


If a small tear or hole develops in the eardrum, your child’s doctor can repair it with a thin tissue, fat, or gel. 


This surgery is used to repair a hole in the eardrum, remove cholesteatoma or inflamed tissue, or repair or replace the three tiny bones behind the eardrum. The surgery takes about one to two hours and is usually done as an outpatient procedure.


A mastoidectomy removes damaged mastoid cells, which are found in the skull behind the ear and can become infected when a chronic ear infection spreads to the skull. This procedure is also used to remove skin cysts, or cholesteatomas, that can develop in the middle ear. This is frequently done in conjunction with tympanoplasty and may take two to three hours overall.

Ossicular Reconstruction

Small bones in the middle ear that are damaged by ear infections or trauma can be repaired or replaced. This procedure, also called ossiculoplasty, uses prosthetic bones to restore function.

Speech Therapy

Children who have hearing problems due to chronic ear infections may start speaking at a later age than other children or have difficulties with speech. Our speech therapists work with your child to help him or her acquire language and improve his or her ability to speak.

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Our pediatric otolaryngologists typically diagnose chronic ear infections based on your child’s symptoms -- ear pain, fever, irritability, temporary hearing loss, and clogged feelings in the ears -- and by looking at the eardrum using an otoscope. This lighted instrument lets the doctor see the eardrum. A red, inflamed eardrum with fluid behind it usually signals an infection is present. Other tests used to check for middle ear infections include:

Pneumatic Otoscope

This tool blows a puff of air into the ear, to see how the eardrum moves. If there is fluid behind the eardrum, it will not move easily.


This test uses sound and air pressure to check the flexibility of the eardrum at different pressures.


This is used to test hearing. There are many techniques that can be used, depending on the child's age and cognitive ability.

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In addition to being among the best in the country, Duke Children's Hospital & Health Center is proud to be nationally ranked in nine pediatric specialties.
Reviewed: 01/19/2018