Signs and Symptoms of Chronic Otitis Media

Warning signs of COM include the following:

  • Persistent blockage or fullness of the ear
  • Chronic ear drainage
  • Development of balance problems
  • Facial weakness
  • Persistent deep ear pain

COM generally occurs gradually over many years in patients with long standing or frequent ear trouble. However, it can occasionally develop over several months in a patient with no previous history of ear disease.

Treatment of Chronic Otitis Media

The first step in treating COM is to have a complete ear examination by an otolaryngologist, a physician who specializes in the medical and surgical treatment of the ear, nose and throat.

Treatment of COM depends upon the stage of the disease. Initially, efforts to control the causes of eustachian tube obstruction, such as allergies or other head and neck infectious problems, may prevent progression of COM. This is the reason many children with chronic eustachian tube problems have ventilation tubes inserted in their eardrums to allow normal airflow in the middle ear until they outgrow the eustachian tube problems.

Once the disease has progressed to the point of significant middle ear damage to the eardrum or ossicles, more intensive treatment is needed. If active infection is present in the form of ear drainage, antibiotic ear drops are prescribed. Occasionally, these may be supplemented with oral antibiotics.
Once the active infection is controlled, surgery is usually recommended.

There are three objectives of surgery for COM:

  • Eradication of the disease
  • Remodeling of the middle ear and mastoid bone, located just behind the external ear, to prevent recurrence of the disease
  • Preservation or improvement in hearing.

Surgery to achieve these objectives is called tympanomastoidectomy. The otolaryngologist first makes an incision behind or around the upper portion of the external ear. Part of the mastoid bone is then drilled away to gain access to the middle ear space. Finally, the abnormal tissues are removed. If possible, efforts are made to rebuild the eardrum and the sound conducting bones. It is sometimes necessary, however, to complete the hearing reconstruction at a later date rather than at the same time as removal of the infected or damaged parts.

Patients are usually discharged from the hospital one or two days after surgery and will have the ear bandaged for a week or two. It takes several months for complete healing and the hearing results may continue to improve throughout the healing phase. Routine checkups by the otolaryngologist are recommended at least yearly after the healing is complete and in some cases may be required two or more times yearly to maintain adequate local hygiene.
Additional Services

As mentioned before, not all patients will require hospitalization and surgery as treatment for COM. However, if surgery is recommended, and you have any questions regarding insurance coverage of your surgery, please feel free to call Mass. Eye and Ear's Office of Patient Accounts at 617-573-3073.

In addition, there are times when a patient may need assistance getting along at home during the days following surgery. The Mass. Eye and Ear’s Social Work and Discharge Planning staff will work with these patients, and if appropriate, with their friends and family members to minimize any hardships the patients might encounter following surgery. If you have any questions, please feel free to call them at 617-573-3540.