Causes, incidence, and risk factors 

Inflammation or infection of the middle ear occurs when the eustachian tube to that ear is blocked. The eustachian tube is the passage from the back of the throat to the middle ear. Chronic otitis media occurs when the eustachian tube becomes blocked repeatedly (or remains blocked for long periods) due to allergies, multiple infections, ear trauma, or swelling of the adenoids.

When the middle ear is actually infected with bacteria (or occasionally, viruses) rather than just inflamed, it is more serious. A chronic ear infection may be the result of an acute ear infection that does not clear completely, or the result of recurrent ear infections. The infection may spread into the mastoid bone (mastoiditis), or pressure from fluid build-up may rupture the eardrum or damage the bones of the middle ear.

A chronic ear infection may be more destructive than an acute ear infection because its effects are prolonged or repeated, and it may cause permanent damage to the ear. However, a chronic, long-term infection may show less severe symptoms -- so the infection may remain unnoticed and untreated for long periods of time.

Ear infections are more common in children because their eustachian tubes are shorter, narrower, and more horizontal than in adults. Chronic ear infections are much less common than acute ear infections. 

Symptoms 

Ear pain or discomfort, earache 
Usually mild
May feel like pressure in the ear 
Pus-like drainage from the ear 
Hearing loss 
Note: Symptoms may be continuous or intermittent, and may occur in one or both ears. 

Signs and tests 

An examination of the ear may show dullness, redness, air bubbles, or fluid behind the eardrum. The eardrum may show drainage or perforation (a hole in the eardrum). The eardrum may bulge out or retract inward.

Cultures of drainage may show bacteria. These bacteria may be resistant or harder to treat than the bacteria commonly involved in acute ear infection.

Mastoid X-rays or a CT scan of the head or mastoids may show spreading of the infection beyond the middle ear. 

Treatment   ( Natural Alternatives Below)

Treatment is focused on relief of symptoms and cure of the infection.

Antibiotics may be prescribed if the infection appears bacterial. Antibiotic treatment is usually long-term and may be oral or in the form of antibiotic ear drops if there is a hole in the eardrum.

Surgical removal of the adenoids may be necessary to allow the eustachian tube to open. A surgical opening may be made in the eardrum (myringotomy) to allow fluid to drain. This may or may not include placement of drainage tubes in the ear. Surgical repair of a ruptured eardrum may prevent further chronic ear infections.

Keep the ears clean and dry to prevent reinfection. This is particularly important if myringotomy has been performed.

Expectations (prognosis) 

Chronic otitis usually responds to treatment, but treatment may be prolonged (over several months). The disorder is usually not a threat to life but may be uncomfortable and may result in serious complications. 

Complications

Permanent damage to the ear with partial or complete deafness 
Mastoiditis 
Cholesteatoma 
Epidural abscess 
Most children will have temporary and minor hearing loss during and right after an ear infection, because fluid can linger in the ear. Although this fluid can go unnoticed, it can cause significant hearing problems in children. Any fluid that lasts longer than 8-12 weeks is cause for concern -- in children, hearing problems may cause speech to develop slowly. 

Permanent hearing loss is rare, but the risk increases the more infections a child has. 

Calling your health care provider 

Call for an appointment with your health care provider if you or your child has signs of chronic otitis media (including an episode of acute otitis media that does not respond to treatment).

Call your health care provider if chronic otitis media does not respond to treatment, or if new symptoms develop during or after treatment. 

Prevention 

Prompt treatment of acute ear infections may reduce the risk of development of chronic otitis media. Follow-up examination after treatment of an ear infection will ensure that it is completely cured. 

 Above photos and information courtesy of The National Library of Medicine 

The key factor in the natural approach to chronic ear infections appears to be allergies, particularly food allergies. The most common allergenic foods should be eliminated from the diet: milk and dairy products, eggs, wheat, corn, oranges, and peanut butter. Supporting the immune system is a good way to fight allergies. 

Nutritional supplements that support the immune system:

Vitamin A - (Beta Carotene)  - Although Vitamin A is probably best known  for promoting and maintaining healthy eyesight, it has other important functions as well. It improves resistance to infection by enhancing immunity, and it's useful in treating vaginal yeast infections, cold sores, shingles and warts. Vitamin A also helps to protect the lining of the  digestive tract and may aid in relieving a number of gastrointestinal problems. It's necessary for normal reproduction, growth, and development, plays a significant role in building strong teeth and bones, and may help to guard against certain cancers. 

Beta Carotene - Beta carotene is an important nutrient found in many colorful green and yellow vegetables like carrots and spinach that is utilized by the body  to produce vitamin A, which is essential to maintaining healthy skin, eyes and a strong respiratory system. Beta carotene is the most potent precursor to vitamin A, but is also a potent antioxidant itself that can help hunt down harmful cell damaging free radicals. 

Vitamin C -  is needed as a coenzyme for many metabolic pathways. Vitamin C is a powerful antioxidant, with important roles in connective tissue, bone and skin health, immune function,
 and cardiovascular health.It is also necessary to convert folic acid into its active form, and helps the body absorb iron. Good food sources of vitamin C include all citrus fruits (oranges, grapefruit, lemons), strawberries, tomatoes, broccoli, Brussels sprouts, peppers, potatoes and cantaloupe.

Zinc - Promotes healthy immune and prostate function.  Supports the enzymatic activity associated with energy metabolism, bone mineralization, and tissue synthesis.

Thymus Gland Extract - improves immune function, decreases food allergies, improves resistance to chronic respiratory infections. May be in particular benefit in treating chronic otitis media. 

Quercetin -  Is a bioflavanoid related to green tea. Reverses symptoms of allergies, athsma, high blood pressure, functions as an antihistamine, good for hives. It relaxes blood vessels, increases metabolism, burns calories, increases thermogenesis.  Quercetin comes from onions, apples, grapes.

Botanical Medicines

Echinacea - Natural antiviral, antibacterial and antifungal properties for your immune system. Traditionally used by Native Americans, echinacea, the purple coneflower, possesses a remarkable mix of chemical constituents with  immune-enhancing, pharmacological properties.

Humidifiers are great treatments for ear infections and upper respiratory tract infections. A study indicated that low humidity may be a contributing factor in otitis media. 

Books On Natural Treatments

Encyclopedia of Natural Medicine - Drawing on the best of centuries-old wisdom and modern knowledge and supported by the latest scientific investigation, "The Encyclopedia of Natural Medicine" explains the principles of natural medicine and outlines  their application through the safe and effective use of herbs, vitamins, minerals, diet, and nutrition. Maladies covered include otitis media, allergies, migraines, premenstrual syndrome, diabetes, herpes simplex, depression, osteoporosis, and more.