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  • Writer's pictureDr. Koralla Raja Meghanadh

Acute vs. Chronic Otitis Media: What You Need to Know

Updated: Apr 1

Acute vs. Chronic Otitis Media: What You Need to Know

Otitis media, commonly known as middle ear infection, is one of the most common infections affecting individuals of all ages. This condition occurs within the middle ear, a part of the ear responsible for transmitting sound vibrations to the inner ear through the eardrum.

Acute otitis media and chronic otitis media are two types of middle ear infections. While both conditions involve middle ear inflammation, they differ in their causes and treatment.

Otitis Media, or middle ear infection that lasts for less than two weeks, is called acute otitis media.

If the infection is more than six weeks old, then it is chronic otitis media.

In this article, we will explore these two variants of otitis media and provide insights into understanding their differences.

Acute Otitis Media

Acute otitis media, also known as acute suppurative otitis media, is characterized by a rapid onset of middle ear infection. The key defining factor of acute otitis media is the speed at which it develops, typically within five days. The symptoms usually appear within five days, and the infection lasts less than two weeks.

Chronic Otitis Media

Chronic otitis media is a condition where inflammation and infection within the middle ear persist for an extended period, typically lasting more than six weeks.

There are different forms of chronic otitis media, like unsafe chronic suppurative otitis media. One type of chronic suppurative otitis media is cholesteatoma. In this condition, there is negative pressure in the middle ear, but there isn't a substantial secretion of fluids. This causes the eardrum to retract into the middle ear, accumulating wax and skin flakes in certain cavities within the middle ear. This accumulation forms a cholesteatoma. Cholesteatoma is a bone-eroding disease.

The difference between Acute and Chronic Otitis Media Causes

Acute Otitis Media

  1. Viral attacks on the nose

  2. Bacterial nasal infections, especially when highly virulent bacteria is involved

  3. Sinusitis

Chronic Otitis Media

  1. Poor management of acute otitis media Untreated acute suppurate Otitis Media: In acute otitis media, if the pressure in the middle ear becomes too high, the fluid/pus accumulated in the middle ear could rupture the ear drum and flow into the outer, or it can slip into the inner ear. This eardrum rupture, known as the perforation of acute suppurative otitis media, can generally heal without complications if treated effectively within three months. If left untreated or partially treated, the condition can advance to chronic otitis media, leading to permanent perforation.

  2. Chronic sinusitis

  3. Recurrent nose infections

  4. Allergies

  5. Congenital anomalies in the drainage and ventilation pathways of the middle ear: These may include mucosal folds that block the airflow and fluid movement from the eustachian tube to the mastoid antrum. If these folds do not dissolve properly during the development of the middle ear around the ossicles (the bones responsible for hearing) in the womb of their mother, the person may be at a higher risk for recurring ear infections.

Symptoms in Acute vs Chronic Otitis Media

The general norm is any acute disease; the symptoms progress quicker than in chronic disease, and the disease stays for a short period in acute. The same goes for otitis media, too.

Symptoms in Acute Otitis Media are shown within five days and should subside within two weeks. Whereas in Chronic Otitis Media, the infection stays for extended periods, and in some cases, the progression of symptoms is slow. Any infection that stays for over six weeks is called Chronic Otitis Media, as mentioned above.

The general list of symptoms of Otitis Media are

  • Severe ear pain

  • Deafness or ear blockage sensation

  • Fever

  • Ear discharge

In Acute Otitis Media, ear pain and fever are more prominent symptoms than the other symptoms.

When the infection is neglected, it can spread to the inner ear causing symptoms like tinnitus and giddiness (vertigo).

Difference in Treatment

It is important to understand the difference between acute and chronic otitis media as the treatment itself varies.

Home Remedies

Although the symptoms in acute otitis media will be more severe than in chronic otitis media, the chances of the acute otitis media resolving without medical intervention and only home remedies are higher. However, it is important to have a medical diagnosis and advice from the doctors to prevent it from causing additional problems or turning chronic. In fact, for any ear infection, it is better to get medical attention, as the possible damages could be irreversible.


Acute infections have gram-positive bacteria, and chronic infections have gram-negative bacteria. So, acute otitis media requires antibiotics that target gram-positive bacteria, and chronic otitis requires antibiotics targeting gram-negative bacteria.

Supportive Treatment for the Root Causes of Otitis Media

Otitis Media is, most of the time, a secondary infection or occurs due to underlying causes like allergy or anatomical anomalies that exist from birth. These conditions need treatment first, and this is not optional. In some cases, especially in acute otitis media, treating the underlying cause alone could be sufficient to treat the disease.

Cold or Rhinitis

90% of ear infections occur due to a cold or infection in the nose (rhinitis). In this case, most of the time, infection in the ear is acute type. Treating nasal infections can alone cure otitis media.

If a person is susceptible to frequent cold or nasal infections, then the person could have chronic otitis media.

Here is how you can treat a cold.

  1. Steam inhalations

  2. Nose drops – Xylometazoline, Oxymetazoline (these drops shouldn’t be used for more than seven days)

Just using these two home remedies can stop the occurrence of middle ear infections. If acute otitis media is already triggered, in most cases, the infection should disappear with these two remedies within five days. If the otitis media doesn’t resolve with these remedies within five days, a medical check-up will be required.

Chronic Sinusitis

As mentioned earlier, chronic sinusitis can lead to Chronic Otitis Media. Even if Otitis Media is treated and chronic sinusitis is left untreated, there could be recurrent infections. Treating chronic sinusitis can prevent recurrent ear infections.

Here are home remedies for how you can treat chronic sinusitis and slow down the progression of chronic otitis media at home.

  1. Adequate sleep

  2. Adequate hydration – click here to calculate how much water you should drink daily as per your body weight.

  3. Steam inhalations

  4. Using a small pinch of black pepper with turmeric and other spices can increase the absorption of micronutrients by our body. This boosts our immune system, thereby helping our body control the infection.

  5. Frequent small exercises in a day.

To learn more about these home remedies. Please check out our article “Home Remedies for Sinusitis”.

For definite treatment and diagnosis of chronic sinusitis, it is better to visit a doctor. The relief from sinusitis symptoms doesn’t always mean eradicating the disease from our body. It is always better to get it confirmed by an ENT doctor. A doctor might suggest the below methods depending on your diagnosis.

  1. Antibiotics

  2. Surgery


Allergy can be responsible for partial blockage in the eustachian tube. When any cause of Otitis Media is experienced by an individual with partial blockage of the eustachian tube, they will be more susceptible to middle ear infections. This could cause them to have recurrent ear infections, resulting in chronic otitis media. Taking long-term anti-allergic medications, which are very safe with almost zero side effects on our body, can not only prevent these infections but also play a major role in treatment.

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