Chronic otitis media is a long-standing inflammatory condition of the middle ear characterized by persistent or recurrent infection lasting for weeks or months. Unlike acute otitis media, which resolves with appropriate treatment, chronic otitis media is associated with structural damage to the eardrum and middle ear, often resulting in ongoing ear discharge and progressive hearing loss. It is a significant cause of preventable hearing impairment worldwide.

The condition typically develops as a complication of inadequately treated acute ear infections or repeated episodes of middle ear inflammation. Persistent Eustachian tube dysfunction leads to poor ventilation of the middle ear, allowing bacteria to survive and multiply. Over time, this results in a permanent perforation of the tympanic membrane or the formation of a cholesteatoma, an abnormal growth of skin cells within the middle ear that can erode surrounding bone.

Symptoms of chronic otitis media commonly include continuous or intermittent ear discharge, reduced hearing, a sensation of fullness in the ear, and occasional ear pain. Unlike acute infections, fever and severe pain are usually absent unless complications develop. Hearing loss is typically conductive but may become mixed or sensorineural if the inner ear structures are affected.

Diagnosis involves detailed otoscopic examination to identify eardrum perforation, discharge, or cholesteatoma. Hearing tests such as pure tone audiometry assess the degree and type of hearing loss. Imaging studies like CT scans may be required to evaluate bone erosion or disease extension, especially before surgical intervention.

Management of chronic otitis media aims to eliminate infection, control discharge, and restore hearing where possible. Medical treatment includes meticulous ear cleaning and topical antibiotic ear drops. Oral antibiotics may be used during acute flare-ups. However, medical therapy alone is often insufficient to achieve long-term resolution.

Surgical treatment is frequently required and may include tympanoplasty to repair the eardrum, ossiculoplasty to reconstruct damaged hearing bones, or mastoidectomy to remove diseased bone and infection. Early surgical intervention significantly reduces the risk of serious complications such as brain abscess, meningitis, and facial nerve paralysis.

Long-term follow-up is essential, as chronic otitis media can recur even after treatment. With timely ENT care and appropriate surgical management, most patients experience significant improvement in ear health and hearing outcomes.