What Is Chronic Middle Ear Disease?

Chronic Middle Ear Disease occurs after repeated middle ear infections, also known as Otitis Media. The symptoms vary greatly, but can include ear discharge, hearing loss, dizziness and tinnitus (ringing in the ear).

Hearing Loss And Middle Ear Disease

The external and middle ear transfer sound to the inner ear. An issue with the inner ear or ear nerve can cause a ‘sensorineural’ or nerve loss, while issues with the external or middle ear can cause a ‘conductive’ hearing loss.

Issues leading to conductive hearing loss may be caused by a hole in the eardrum (perforation), or destruction of one or more of the three small hearing bones (ossicles). An acute infection may also develop in the middle ear which can result in an eardrum perforation. The perforation may fail to heal and lead to intermittent or constant ear drainage and hearing loss.

Non-surgical Treatment

Non-surgical treatment can be useful for patients with a perforation. Treatment involves ear drops, antibiotics, and careful cleaning of the ear by an ear surgeon. Water should be prevented from entering the ear.


Modern surgical techniques make it possible to reconstruct the eardrum with a low risk of complications, often leading to a marked improvement in hearing.

Tympanoplasty or Myringoplasty

A tympanoplasty or myringoplasty is an operation that removes infection from the middle ear lining and closes the perforation in the eardrum. A tympanoplasty can also involve repairing the small bones of hearing if they are damaged.

The operation can be performed under local anaesthetic combined with intravenous sedation (the patient is drowsy), or a general anaesthetic.

A small incision is made near the top of the ear canal and a graft is taken to use on the eardrum. An incision can be made behind the ear if special techniques are required to enlarge the ear canal. The procedure often requires two operations to complete the reconstruction.

The small hearing bones may be replaced by a synthetic prosthesis, your own cartilage, or they may be repositioned. The patient is hospitalised for one or two nights and can return to work in seven to 10 days. Antibiotic packing is placed in the ear canal, which can be removed at the first post-operative visit. The ear will not fully heal for at least six weeks, and water should be prevented from entering the ear canal during that time.

Tympanoplasty and Mastoidectomy

In some cases, infection of the middle ear and mastoid becomes chronic, and persistent drainage occurs despite all measures. Chronic infection can lead to permanent hearing loss, dizziness, or sometimes more serious side effects. These situations usually require a tympanoplasty with mastoidectomy.

The tympanoplasty and mastoidectomy procedure removes the diseased lining of the mastoid bone and middle ear through an incision behind the ear so the eardrum can be reconstructed. The procedure requires a general anaesthetic and usually one night in hospital. The patient can usually return to work within one or two weeks.

Chronic Middle Ear Diseases - Related Content


A cholesteatoma is an abnormal skin growth in the middle ear behind the eardrum. Repeated infections can allow skin to build up in the middle ear. The growth, however, is not cancerous. Cholesteatomas often develop as cysts or pouches that shed layers of old skin inside the middle ear. Over time, the cholesteatoma can grow and damage the surrounding delicate bones of the middle ear. This can lead to hearing loss that surgery can often improve.

Otitis Media

Otitis media is a condition often seen in children (but can occur in adults) where chronic ear infections lead to fluid build-up in the ear. The condition is commonly known as ‘glue ear’, and can be painful, causing inflammation and sometimes fever.

Perforations of the Eardrum

The eardrum is connected to the nose by the eustachian tube, which equalizes pressure. A perforated eardrum occurs when the thin membrane separating the ear canal and the middle ear (the eardrum) ruptures, or a hole forms. The perforation almost always causes some degree of hearing loss.