Chronic Otitis Media (COM)

What is 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). It is treated by the Division of Otolaryngology, also known as Ear, Nose and Throat (ENT), at The Children's Hospital of Philadelphia.


Your child may develop COM from a perforation — or hole — in the ear drum caused by:

  • A trauma — such as poking a stick in the ear or from a slap on the auricle (ear lobe)
  • An ear infection
  • Incomplete healing of the ear drum after an ear tube (tympanostomy tube) was dislodged or taken out

The perforation may be accompanied by drainage from the ear and/or conductive hearing loss.


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. 

When 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). 



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.


Surgical removal of cholesteatoma with tympanoplasty and/or mastoidectomy is recommended to prevent complications.

Reviewed by Steven D. Handler, MD, MBE, FACS, FAAP