Chronic middle ear infection can cause persistent foul-smelling ear discharge and hearing loss. This is due to a perforation of the eardrum and recurrent infection of the middle ear. The ear perforation is usually the result of previous trauma or infection.

In most instances, the eardrum will heal, but occasionally the perforation persists. It is important to ensure that the patient does not have cholesteatoma.

Recurrent ear discharge, pain and hearing loss are the most common symptoms. The ear discharge and pain are due to infection and hearing loss due to perforation of the eardrum and occasionally, erosion of the ossicles in the middle ear.

Part of the skin of the ear grows into the bone of the middle ear in someone with a cholesteatoma. With chronic infection and as the cholesteatoma grows, it can cause chronic ear discharge, hearing loss, facial paralysis and even meningitis and brain abscess.

Diagnosis is made from history and examination with an otoscope. An ear perforation can be easily seen. From the exam, the doctor will be able to ensure that you do not have a cholesteatoma.

A hearing test (audiogram) is often necessary. If cholesteatoma is suspected then a CT scan of the temporal bone may be ordered.

You will be advised to keep your ear dry and topical antibiotics will be prescribed. It may be necessary to obtain some ear discharge to culture for bacteria so that the species of bacteria can be identified and the most appropriate antibiotic prescribed.

Surgical treatment such as myringoplasty, tympanoplasty or ossiculoplasty may be needed to repair the eardrum and/or to reconstruct the ossicles if there is troublesome discharge or the hearing loss is significant.

Surgical treatment of cholesteatoma is necessary. The surgical procedure, tympanomastoidectomy, involves removal of the cholesteatoma, the affected bone and the middle ear structures.