There are several conditions under the general heading of middle ear disease such as otitis media, chronic Suppurative Otitis Media (CSOM), Eosinophilic Otitis Media (EOM), cholesteatoma and mastoiditis. Most middle ear infections, such as otitis media, clear up on their own within a few days and don't need any specific treatment.

Chronic middle ear disease refers to a condition of the middle part of the ear that doesn’t go away - or that keeps coming back. If the disease causes an infection, fluid or swelling behind the eardrum it can result in long-term or permanent damage to the ear.

In these cases, surgery may be recommended to provide a positive long-term solution. Options include: 

• Repairing the eardrum
• Inserting an ear tube
• Mastoiditis treatment includes removing infection from the mastoid bone (mastoidectomy)
• Repairing or replacing the small bones in the middle ear

Each type of chronic middle ear infection has its own causes:

Cholesteatoma

Cholesteatoma is an abnormal collection of skin cells deep inside your ear. They’re rare but, if left untreated, can damage the delicate structures inside your ear that are essential for hearing and balance.

A cholesteatoma can also lead to:

• An ear infection or discharge from the ear
• Hearing loss, which can be permanent
• Vertigo
• Tinnitus
• Damage to the facial nerve which may cause weakness in one side of your face                         

Mastoiditis

An infection of the mastoid bone in the inner ear or the bone behind the ear, both cholesteatoma and mastoiditis are usually caused by an infection of the middle ear, which spreads into the surrounding bone (the mastoid process). Mastoiditis symptoms include pain in the bone behind the ear or in the ear.

Chronic Suppurative Otitis Media (CSOM)

CSOM often results in an ongoing cycle of infection causing inflammation, ulceration, and granulation. This may result in damage of the surrounding ear.

Eosinophilic Otitis Media (EOM)

The exact cause of is unknown, but it is thought to be associated with bronchial asthma and nasal allergies. It can sometimes lead to hearing loss.

Symptoms of a chronic middle ear disease may include:

• Mild pain in ear
• Pressure in the ear
• Fluid build-up, or fluid draining from the affected ear
• Fever
• Hearing loss
• Impaired balance
• Confusion or sleepiness
• Facial weakness
• Difficulty sleeping

You might experience a range of symptoms, depending on the condition, such as cholesteatoma in both ears or just one and they may be constant or might come and go.

If you suspect your eardrum has perforated, you should contact your GP as soon as possible.

Your Consultant will assess your condition using a medical device (otoscope or auriscope) to look into your ears. If you have a discharge from your ears a sample may be taken for testing and diagnosis.

They’ll also be able to refer you for other tests, if required. For example, if they suspect cholesteatoma, you might need a CT scan or an MRI scan.

Surgery will normally be carried out under a general anaesthetic so you’ll be asleep during the procedure. During the operation the surgeon will be using very small, precision instruments while looking at the area through a microscope.

Depending on the exact nature of the condition, different operations will be required.

During a myringotomy a tiny incision is made in the eardrum (tympanic membrane) to relieve pressure caused by an excessive build-up of fluid, or to drain pus from the middle ear.

A myringoplasty is the closure of a hole (perforation) in the eardrum. When a myringoplasty is combined with a reconstruction of the small bones of the ear, the procedure is called a tympanoplasty. If a hole in the eardrum needs to be repaired, the surgeon may use a piece of your own tissue from near the ear.

If the bones in your ear need replacing or repairing (ossiculoplasty), the surgeon will either use a synthetic bone or sometimes part of your own bone. If infection of the mastoid (the air cavity behind the middle ear) is suspected then the surgeon may also examine this area.

To get a good view and to access your eardrum the surgeon may need to make a cut either behind or in front of the ear.

If you’ve had a general anaesthetic, you won’t be able to drive for 24 hours after surgery.

There may be some pain after the anaesthetic wears off and we’ll help relieve this with painkillers. Before you go home we’ll discuss any aftercare requirements or follow-up appointments with you.