What Can Cause Chronic Ear Infections?

There are multiple causes for recurring (chronic) ear infections, or recurring otitis media, ranging from allergies, sinusitis, ear injuries, and bacterial infections from colds or flu.

This medical condition can result in a ruptured eardrum, hearing loss, balance function, or in protracted cases, facial inflammation or paralysis. Getting medical help quickly is necessary to maintain good hearing health—especially for young children, as the ability to hear is necessary for learning language.

Chronic Ear Infection, Defined

Otitis media affects the space behind the eardrum (middle ear) and is diagnosed as ‘chronic’ when an ear infection does not heal or if it is recurring. The acute version tends to come on quickly and is of shorter duration but symptoms may be more severe. The Eustachian tube, which drains fluids away from the middle ear, may become plugged due to a viral or bacterial infection, allowing a buildup of fluid to press against the eardrum. Otitis externa, or swimmer’s ear, affects swimmers when contaminated water enters the ear, allowing the growth of bacteria and infection in the outer ear.

Young children and infants are more likely to develop ear infections due to the Eustachian tubes' being smaller and more horizontal than those of adults, making it harder for fluid to drain away. Adults are more likely to get infections from swimming, injuries (such a foreign body in the ear), or following upper respiratory illnesses.

Fluid buildup alone (called otitis media with effusion, or O.M.E.) is a separate and distinct condition, and is not helped by the antibiotics commonly used for acute otitis media.


The symptoms may be milder for recurring ear infections compared to more acute forms, may come and go, and affect one or both ears. Common symptoms may include any of the following:

  • Low fever
  • Pressure in the ear
  • Pus-like fluid draining from the affected ear
  • Ear pain, usually mild but may be severe in acute cases
  • Difficulty hearing
  • Difficulty sleeping

In infants, outside of fever, trouble sleeping and eating as well as increased fussing, or pulling on the affected ear are often the only indicators of an ear infection.


Sometimes ear infection symptoms can be treated at home until the patient is able to get an appointment to see the doctor or visit a hospital or urgent care medical center. Warm cloths applied against the ear as well as over-the-counter (OTC) pain relievers can be helpful. Waiting until an annual physical to discuss this is usually not a good idea, even if the symptoms seem mild, as damage can occur regardless of the pain level.

During the examination, the physician may order tests such as fluid cultures looking for bacteria or a CT scan to determine if the infection has spread beyond the middle ear.

Your doctor will usually prescribe antibiotics to clear up any infection and sometimes antibiotic ear drops, particularly if the eardrum has been perforated. According to the American Academy of Pediatrics (AAP), physicians are being encouraged to take a more wait-and-see approach due to over-prescription of many common antibiotics, leaving questionable evidence for use as well as subjecting patients to other side effects such as stomach complaints or allergic reactions.

In severe cases of chronic ear infections, surgery may be indicated. The surgeon inserts small tubes through a tiny hole in the eardrum, connecting the middle ear to the outer ear, enabling fluid to drain out. This procedure, usually performed on both ears, is called a bilateral myringotomy and can help reduce the frequency and severity of an ear infection and its symptoms.

If the infection has spread, more surgery may be needed to repair or replace the affected tiny bones or eardrum of the middle ear. If the infection has spread to the mastoid bone behind the ear, a surgeon will perform a mastoidectomy to remove the infected area. 


  • Wash hands frequently to reduce the spread of viruses and bacteria—often the root cause of the infection in the first place.
  • Breastfeed infants to reduce upper respiratory illnesses, recommends the AAP.
  • Stop smoking and eliminate exposure to second-hand smoke.
  • Keep vaccinations up to date for pneumonia, meningitis, and influenza. Since 2000, when the pneumococcal vaccine was introduced, the incidence of ear infections has dropped by over 20 percent.
  • Finally, be sure to have a follow-up exam at your doctor’s recommendation to ensure that the infection has been cured completely.

For more updates on family health matters, such as chronic ear infections, please visit our Ear, Nose and Throat medical services page on our website.