Pain and fever are usually absent but can occur during sporadic flare-ups. Diminished hearing and foul otorrhea are major symptoms. Physical examination discloses perforation of the tympanic membrane. Central perforations of the pars tensa are associated with benign disease, but peripheral perforations may occur with invasive cholesteatomas. X-rays reveal sclerosis of the mastoid air cells and bone destruction.
Antibiotics are generally of little benefit, and surgery is required in advanced cases.
Without therapy, chronic otitis media can cause the same intracranial suppurative complications seen in acute otitis media. Patients have pruritus or pain, or both, that may be severe. Crusting, inflammation, and discharge in the canal are typical findings, and pain resulting from movement of the external ear helps distinguish otitis externa from otitis media. Topical therapy with ear drops containing polymyxin B and neomycin produces excellent results, but patients occasionally acquire true cellulitis of the external ear and then require systemic antibiotics and even debridement of infected cartilage. Malignant otitis externa, an infection with P. aeruginosa that progressively invades the cartilage, soft tissue, and skull, is a rare condition that occurs in diabetics.