Chronic otitis media

Last updated: May 20, 2022

Summarytoggle arrow icon

Chronic otitis media (OM) refers to a group of chronic inflammatory diseases of the middle ear, which often affects children. Chronic suppurative otitis media (CSOM) is characterized by a persistent drainage from the middle ear through a perforated tympanic membrane (TM). The condition is often seen in patients with a history of acute otitis media with TM rupture and presents with painless otorrhea and conductive hearing loss. The diagnosis is confirmed by detection of a TM defect during otoscopy. Treatment consists of conservative measures (e.g., antibiotic drops) and tympanoplasty if conservative management fails. Chronic otitis media with effusion (OME) is most likely caused by eustachian tube dysfunction (ETD) and is characterized by a buildup of effusion behind the intact TM. Clinically, OME presents with a sensation of fullness or pressure in the ear, as well as conductive hearing loss. The effusion often resolves spontaneously and treatment (e.g., placement of tympanostomy tubes) is only indicated if hearing impairment occurs or if the effusion persists. Acute OME in adults should raise suspicion of a nasopharyngeal malignancy and prompt swift evaluation.


Chronic OME in children

In children, reduced hearing ability due to OME may result in speech and language impairment. Therefore, early initiation of treatment is important!

Pharmacologic therapy (e.g., oral steroids, antihistamines, nasal decongestants, antibiotics) shows little effect and is not generally recommended!

Acute OME in adults


  1. Lustig LR, Limb CJ, Baden R, LaSalvia MT. Chronic Otitis Media, Cholesteatoma, and Mastoiditis in Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. updated: April 27, 2017. Accessed: April 15, 2017.
  2. Roland PS. Chronic Suppurative Otitis Media. In: Meyers AD, Chronic Suppurative Otitis Media. New York, NY: WebMD. Updated: March 15, 2017. Accessed: May 15, 2017.
  3. Isaacson GC. Cholesteatoma in Children. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. updated: August 17, 2016. Accessed: May 15, 2017.
  4. Higgins TS. Otitis Media With Effusion. In: Meyers AD, Otitis Media With Effusion. New York, NY: WebMD. Updated: April 25, 2017. Accessed: May 15, 2017.
  5. Ramakrishnan K, Sparks RA, Berryhill WE. Diagnosis and treatment of otitis media. Am Fam Physician. 2007; 76 (11): p.1650-1658.
  6. Rosenfeld RM, Shin JJ, Schwartz SR et al. . Clinical practice guideline: Otitis media with effusion (update). undefined. 2016; 154 (1): p.S1-S41. doi: 10.1177/0194599815623467 . | Open in Read by QxMD
  7. Klein JO, Pelton S. Otitis Media With Effusion (Serous Otitis Media) in Children: Management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. updated: August 3, 2016. Accessed: May 15, 2017.

3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer