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 (ENTs) 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 any temporary hearing loss, and prevent future illness.

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About Chronic Ear Infections

Children may experience frequent ear infections because the insides of their ears are not yet 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 keep the pressure behind the eardrum 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 allergies 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:

  • Cholesteatoma: In severe cases, a skin cyst (cholesteatoma) may develop in the middle ear or mastoid (part of the skull behind the 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.
  • Hearing Loss: While hearing loss associated with chronic ear infections is rarely permanent, it can occur when an untreated infection damages the eardrum, the bones of the ear, or (in very rare instances) the hearing nerve.
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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 start by keeping a close eye on your child’s 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 to help prevent future ear infections. Ear tubes help prevent fluid from backing up and getting infected, and they allow infections to drain out of the ear. They also allow air into the ear and help regulate air pressure. These tubes usually fall out on their own as children grow. This short procedure takes only about 15 minutes.

Ear tubes are very beneficial for some children. But they aren't right for everyone. 

Other Surgical Procedures

Surgery to treat chronic ear infections is usually performed on an outpatient basis (meaning your child will have surgery and go home the same day), and your child will be asleep under general anesthesia.

  • Myringoplasty: If a small tear or hole develops in the eardrum, your child’s doctor can repair it surgically by attaching a thin layer of tissue, fat, or gel. This procedure usually takes about 30 minutes.
  • Tympanoplasty: This surgery is used to repair a hole in the eardrum, remove a cholesteatoma or inflamed tissue, or repair or replace the three tiny bones behind the eardrum. The surgery takes about one to two hours. This can often be done directly through the ear canal, so there are no external incisions required.
  • Mastoidectomy: A mastoidectomy removes damaged mastoid cells, which are found in the skull behind the ear. These cells 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. Mastoidectomy 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, and it usually takes one to three hours.

Speech Therapy

Children who have hearing problems due to chronic ear infections may have speech difficulties or delays. Our speech therapists help your child to acquire language and improve their 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.


Used to test hearing, there are many audiometry techniques available to match each child's age and developmental level.

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Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

This page was medically reviewed on 08/08/2022 by