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Ear, Nose, and Throat Disorders

Chronic Ear Infection: The Diseased Middle Ear

Any disease affecting the eardrum (tympanic membrane), or the three small ear bones (ossicles) may cause a hearing loss by interfering with the transmission of sound to the inner ear. Infections may cause:

When an infection develops in the middle ear, the eardrum may rupture, resulting in a perforation (hole). This perforation usually heals. Hearing loss occurs, often associated with head noise (tinnitus) and ear drainage.

If a perforation is present, you should not allow water to get into your ear canal. This may be avoided when showering or washing the hair by placing cotton in the external ear canal and covering it with a layer of Vaseline. If you desire to swim, use a tight fitting swimming cap or use earplugs.

In the event of ear drainage you should see an ear doctor (otolaryngologist). Medication, as prescribed, should be used if discharge is present or when discharge occurs. Cotton may be placed in the outer ear to catch any discharge but should not be allowed to block the ear canal for long periods.

Treatment

Medical treatment will frequently stop ear drainage. Treatment consists of careful cleaning of the ear and, at times, the application of antibiotic powder or eardrops. Oral antibiotics may be helpful in certain cases.

Surgical Treatment - For many years, surgical treatment was used to control infection and prevent serious complications. In recent years, changes in surgical techniques have made it possible to reconstruct the diseased hearing mechanism in most cases. Various tissue grafts are used to replace or repair the eardrum. Hearing improvement is rarely noted at or immediately following surgery. Instead, it requires weeks to months for complete healing to occur.

Myringoplasty - Most ear infections go away and the structures of the middle ear heal completely. In some cases, however, the eardrum may not heal, causing a permanent perforation (hole) in the eardrum. Myringoplasty repairs a perforation in the eardrum when there is no middle ear infection or disease of the ear bones. This procedure seals the middle ear and improves the hearing in many cases. Surgery is usually performed behind the ear canal under general anesthesia. Healing is complete in most cases in three to four weeks, at which time any hearing improvement is usually noticeable.

Tympanoplasty - An ear infection may cause a perforation in the eardrum and may also damage the three bones that transmit sound from the eardrum to the inner ear and hearing nerve. Tympanoplasty is the operation performed to repair both the sound transmitting mechanism and the perforation in the eardrum. This procedure seals the middle ear and improves hearing in many cases. Surgery is performed from behind the ear under general anesthesia. Healing of the eardrum is usually complete in three to four weeks, and the hearing improvement may be noticeable at this time (but may take longer).

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Last Reviewed: Feb 15, 2008

Ravi N Samy, MD, FACS Ravi N Samy, MD, FACS
Assistant Professor of Otolaryngology, Director of Skull Base Surgery Fellowship, Director of Adults Cochlear Implantation Program
College of Medicine
University of Cincinnati

David  L Steward, MD David L Steward, MD
Professor of Otolaryngology
College of Medicine
University of Cincinnati