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Chronic Otitis Media

What Chronic Otitis Media?

Chronic otitis media (COM) is a condition of the ear that is defined as a long-standing perforation (hole) of the ear drum or the presence of cholesteatoma (skin-lined cyst).


A perforation may occur as a result of trauma (such as poking a stick in the ear or from a slap on the auricle) or from ear infection. A perforation may also occur if there is incomplete healing of the ear drum after a tympanostomy tube has extruded. The perforation may be present with drainage from the ear and/or conductive hearing loss. Infections associated with ear perforations are treated with topical ear drops and/or oral antibiotics. If a perforation does not heal after 4-6 months, surgical repair with tympanoplasty is recommended.


A cholesteatoma is a skin-lined sac that forms when skin from the external ear canal enters the middle ear space. This cyst is usually associated with a perforation or it can form as a result of recurrent acute ear infections or chronic middle ear effusion.

Occasionally, cholesteatomas are congenital, which means, they form in the middle ear before the child is born. As the cholesteatoma enlarges, it can lead to complications such as erosion of the middle bones (ossicles), mastoiditis (infection of the mastoid), inner ear damage or irritation of the facial nerve (nerve that controls movement of the face). Surgical removal of cholesteatoma with tympanoplasty and/or mastoidectomy is recommended to prevent these complications.

Reviewed by: Steven D. Handler, MD, MBE
Date: April 2009

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