Chronic Otitis Media Treatment in Singapore

Dealing with persistent ear pain, discharge, or hearing difficulties can impact your daily life and overall well-being. Chronic otitis media, a long-standing infection or inflammation of the middle ear, affects individuals in Singapore, from young children to adults. While this condition can be challenging to manage, medical advances have made treatment options available. Our ENT Specialist provides comprehensive evaluation and treatment options tailored to each patient’s specific condition, which may help support ear health and aim to reduce complications.

Individual results and timelines may vary.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

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Overview Types Causes Symptoms When To See a Doctor Diagnosis Treatment Complications Prevention FAQ

What is Chronic Otitis Media?

Chronic otitis media is a persistent infection or inflammation of the middle ear lasting more than three months. Unlike acute ear infections that resolve quickly with treatment, chronic otitis media involves ongoing damage to the middle ear structures, often with a perforated eardrum and recurrent ear discharge. This condition can affect one or both ears and may lead to permanent hearing loss if left untreated.

Chronic otitis media can affect individuals across different age groups and communities. The chronic nature of this condition requires medical attention and often long-term management strategies.

Types of Chronic Otitis Media

Chronic Suppurative Otitis Media (CSOM)

This form involves persistent ear discharge through a perforated eardrum for at least six weeks despite appropriate treatment. CSOM typically presents with painless ear discharge and gradual hearing loss. The discharge may be intermittent or continuous, often worsening during upper respiratory infections.

Chronic Otitis Media with Effusion

Also known as “glue ear,” this type involves fluid accumulation in the middle ear without active infection. The fluid becomes thick and sticky over time, causing hearing difficulties and a feeling of fullness in the ear. This form can be seen in children and adults.

Chronic Otitis Media with Cholesteatoma

This form involves abnormal skin growth in the middle ear behind the eardrum. Cholesteatomas can erode surrounding bone structures and may lead to complications if untreated. Patients often experience foul-smelling discharge, hearing loss, and occasionally dizziness or facial weakness.

Causes & Risk Factors

Causes

Chronic otitis media typically develops from multiple factors working together. Recurrent acute ear infections that fail to completely resolve may progress to chronic infection. Eustachian tube dysfunction prevents proper drainage and ventilation of the middle ear, creating conditions that may favour bacterial growth. Resistant bacterial strains, particularly Pseudomonas aeruginosa and Staphylococcus aureus, can colonise the middle ear in chronic cases. Previous ear trauma or surgery may also predispose individuals to chronic infection.

Risk Factors

Early childhood ear infections may increase the risk of developing chronic otitis media later
Exposure to cigarette smoke and air pollution
Allergic conditions affecting the upper respiratory tract
Craniofacial abnormalities, including cleft palate
Immunodeficiency conditions or immunosuppressive medications
Swimming or water exposure without proper ear protection
Living in crowded conditions or attending daycare facilities
Family history of chronic ear problems
Nutritional deficiencies, particularly vitamin A deficiency
Previous radiation therapy to the head and neck region

Signs & Symptoms

Mild Symptoms

Intermittent ear discharge that may be clear or slightly cloudy
Mild hearing difficulty, especially in noisy environments
Occasional ear fullness or pressure sensation
Slight ear discomfort after water exposure
Intermittent itching inside the ear canal

Moderate Symptoms

Persistent ear discharge with odour
Noticeable hearing loss affecting daily communication
Recurrent ear pain, particularly during infections
Tinnitus (ringing or buzzing in the ear)
Difficulty with balance during physical activities
Frequent need to ask others to repeat themselves

Resolution Phase

Profuse, foul-smelling ear discharge with blood
Severe hearing loss or sudden hearing deterioration
Intense ear pain or headaches
Vertigo (spinning sensation) and nausea
Facial weakness or paralysis on the affected side
Fever and signs of spreading infection

Symptoms of chronic otitis media often develop gradually over time, with periods of improvement and worsening. Some patients may adapt to their symptoms over time, potentially not realising the extent of their hearing loss until formally tested.

Experiencing these symptoms?

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Consult with an ENT specialist for proper diagnosis and treatment options.

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When to See a Doctor

Persistent ear discharge lasting more than two weeks despite basic treatment warrants medical evaluation. Any hearing loss, whether sudden or gradual, requires professional assessment. Seek care if you experience severe ear pain, high fever, dizziness, facial weakness, or swelling behind the ear, as these may indicate complications.

During your consultation, an ENT specialist typically conducts an examination of your ears using an otoscope or microscope. The evaluation includes medical history, hearing assessment, and possibly imaging studies. Early intervention in chronic otitis media may help improve treatment outcomes and reduce the risk of complications.

Diagnosis & Testing Methods

Otoscopic Examination

Otoscopic examination forms the foundation of diagnosis, allowing direct visualisation of the eardrum and middle ear structures. ENT doctors use microscopes to identify perforations, discharge characteristics, and signs of cholesteatoma.

Audiometry

Audiometry testing measures the extent and type of hearing loss, distinguishing between conductive and sensorineural components. This test can provide information for treatment planning.

Tympanometry

Tympanometry assesses middle ear function and eardrum mobility, helping identify fluid accumulation or eardrum perforations. CT scanning offers detailed images of the temporal bone, revealing the extent of disease and any complications such as bone erosion or cholesteatoma. MRI may be necessary when intracranial complications are suspected.

Bacterial culture and sensitivity testing of ear discharge can guide antibiotic selection, particularly in resistant cases. ‘

Treatment Options Overview

Ear Toilet and Aural Care

Regular cleaning of the ear canal and middle ear by an ENT specialist removes infected debris and discharge, promoting healing. This procedure uses microscopic visualisation and specialised instruments, and may provide symptom relief and improve medication penetration. Sessions may be needed at regular intervals initially.

Topical Antibiotic Drops

Antibiotic ear drops deliver medication directly to the infection site whilst minimising systemic side effects. Fluoroquinolone drops can be effective against bacteria in chronic otitis media. Treatment duration varies, with specific instructions on proper administration technique provided.

Oral Antibiotics

Systemic antibiotics may become necessary when topical treatment is insufficient or when complications develop. An ENT specialist selects antibiotics based on culture results and local resistance patterns. Treatment duration varies, with regular monitoring for effectiveness and side effects.

Topical Steroids

Steroid ear drops can help reduce inflammation and granulation tissue in the middle ear, potentially improving drainage and healing. These medications are often combined with antibiotics. Treatment duration varies based on inflammation severity and response to therapy.

Chemical Cautery

Application of silver nitrate or trichloroacetic acid to small perforations may stimulate healing and closure. This office-based procedure may require multiple sessions and can be considered for smaller perforations. Outcomes vary depending on perforation location and patient factors.

Myringoplasty

This procedure repairs eardrum perforations using graft material, typically fascia or cartilage from the patient. The surgery is performed under general anaesthesia. Recovery involves keeping the ear dry for several weeks postoperatively.

Tympanoplasty with Ossiculoplasty

When chronic infection damages the tiny bones of hearing, reconstruction may be considered. This procedure combines eardrum repair with ossicular chain reconstruction using prosthetic devices or cartilage grafts. The surgery aims to restore both the integrity of the middle ear and hearing function.

Mastoidectomy

Removal of infected mastoid bone may become necessary when the disease extends beyond the middle ear. This procedure aims to eliminate infection sources and improve drainage pathways. Depending on the extent, an ENT specialist may perform canal wall up or canal wall down procedures, each with specific considerations.

Endoscopic Ear Surgery

Minimally invasive endoscopic techniques allow treatment through the ear canal without external incisions. This approach offers visualisation and may reduce recovery time. Suitable candidates include those with limited disease and favourable ear canal anatomy.

Every patient’s condition is unique.

An ENT specialist can assess your specific situation and recommend the most suitable treatment approach for you.

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Complications if Left Untreated

Untreated chronic otitis media may lead to progressive hearing loss, which could become permanent as damage accumulates over time. The infection may spread to surrounding structures, potentially causing mastoiditis (bone infection), labyrinthitis (inner ear infection), or facial nerve paralysis. Cholesteatoma formation represents a serious complication, as this abnormal skin growth can erode through bone and vital structures.

Intracranial complications may include meningitis, brain abscess, and lateral sinus thrombosis. These serious infections require emergency treatment and may result in neurological consequences. The chronic drainage and odour associated with untreated disease can impact quality of life, affecting social interactions and employment opportunities. Children with untreated chronic otitis media may experience speech and language delays, academic difficulties, and behavioural problems related to hearing impairment.

This information is provided for educational purposes and should not replace professional medical consultation.

Prevention

Prompt treatment of acute ear infections may help prevent progression to chronic disease. Complete prescribed antibiotic courses and attend follow-up appointments to support infection resolution. Protect ears from water during swimming or bathing using properly fitted earplugs to help reduce infection risk, particularly in those with eardrum perforations.

Manage allergies and upper respiratory conditions to help maintain Eustachian tube function and reduce middle ear problems. Avoid cigarette smoke exposure, both active and passive, to help decrease chronic otitis media risk. Maintain good ear hygiene without using cotton swabs to prevent trauma and infection. Regular hearing checks can help identify problems early, allowing timely intervention. For high-risk individuals, pneumococcal and influenza vaccinations may help reduce the frequency of upper respiratory infections that can trigger ear problems.

For Singaporeans & Singapore Permanent Residents

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Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.

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Frequently Asked Questions (FAQ)

Can chronic otitis media be completely cured?

Chronic otitis media can be treated and managed, but outcomes depend on disease extent, underlying causes, and treatment compliance. Many patients may achieve disease control with appropriate medical or surgical treatment. Some may require ongoing management to prevent recurrence. An ENT specialist may discuss realistic treatment goals based on your specific condition during consultation.

Is surgery always necessary for chronic otitis media?

Surgery is not always required. Some cases may respond to medical management, including ear cleaning, topical medications, and oral antibiotics. Surgery becomes necessary when medical treatment fails, complications develop, or structural problems like persistent eardrum perforations need repair. An ENT specialist recommends surgery only when the benefits clearly outweigh the risks.

How long does recovery take after ear surgery?

Recovery time varies depending on the specific procedure and individual factors. Hearing improvement may occur gradually as swelling resolves and the ear heals. Individual results and timelines may vary. An ENT specialist provides detailed post-operative instructions tailored to your specific surgery.

Can chronic otitis media affect both ears?

Yes, chronic otitis media can affect one or both ears, though unilateral (one-sided) involvement is more common. Bilateral disease may indicate underlying systemic factors like immune deficiency or Eustachian tube dysfunction. Treatment approaches may differ for bilateral disease, sometimes requiring staged procedures to maintain hearing during recovery.

Can children with chronic otitis media participate in swimming?

Swimming restrictions depend on the presence of eardrum perforation and current disease activity. Children with intact eardrums and controlled disease may swim with proper ear protection. Those with perforations should avoid water exposure until surgical repair and healing are complete. Custom-fitted swimming earplugs may provide protection for selected cases. An ENT specialist may provide specific recommendations based on your child’s condition.

What follow-up care is needed after treatment?

Regular follow-up appointments monitor treatment response and detect early recurrence. Long-term surveillance includes periodic hearing tests and ear examinations. Patients with cholesteatoma or those who underwent canal wall down mastoidectomy require ongoing annual reviews. Consistent follow-up care may improve long-term outcomes.

Conclusion

Chronic otitis media, while challenging, can be managed with appropriate medical care and patient commitment. Treatment options, ranging from medical management to surgical techniques, may help with disease control and hearing preservation. Early intervention may be important in preventing complications. Our ENT Specialist combines experience with current evidence-based approaches to provide treatment plans for each patient’s unique situation.

Take the First Step Towards Better Ear Health

Living with chronic otitis media can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating chronic otitis media using current evidence-based approaches.

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Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.

Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
2016 – Best Educator Award (Eastern Health Alliance)
2016 – “Wow” Award (Patient Compliment)

2014 – Eastern Health Alliance Caring Award – Silver
2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
2012 – Human Manpower Development Award (Ministry of Health, Singapore)
2007 – Singhealth Best Doctor Award

Qualifications

MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
FAMS – Fellow of the Academy of Medicine Singapore

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