A young girl in her teens was hospitalized with high fever. She also complained of reduced hearing in the right ear for over one month.  It was later known that she had mucopurulent discharge from her right ear since about 10 years and now the problem has increased. Chronic infection or inflammation of the middle ear may be associated with perforation of the tympanic membrane. There is usually purulent or mucopurulent discharge from the ear. The discharge if very small in quantity is seen only on examination of the middle ear.  But if it is more, it can come out and is felt subjectively by the person.Chronic ear infection is most commonly caused by bacterial infections, though    they can occur due to other infectious agents also. Streptococcus pneumonia is the most common microbe causing it. Infection by Pseudomonas aeorginosa, H. influenza and Moraxella catarrhalis, e.t.c., germs is also responsible for chronic ear infections.  Respiratory synctial viruses which cause common cold also lead to chronic middle ear infections. There can be secondary infection by bacteria over this infection.Perforation can develop in middle ear due to long standing infection and inflammation. Using pins or needles, e.t.c. objects for scratching inside the ears, recurrent cold and sneezing, presence of water in the ear also occurs during a shower or swimming, are some of the common risk factors for causing chronic infections of the ear. One gets pain in the ears as inflammation starts.  As pus builds up behind the ear it causes intense pain. As the quantity of pus increases, there is a visible purulent discharge. These symptoms may be associated with headache and high fever. Lymph nodes surrounding the ears may become enlarged and painful as infection drains in to them.  Untreated, the infection may spread to the brain substance and its coverings. It can spread to the lungs causing pneumonia. Via blood stream, the infection can become generalized resulting in septicemia. Long standing infection damages the inner ear causing deafness.  This condition is a major cause for preventable deafness in young adults. A person of any age or gender can develop chronic middle ear infection. Children are more susceptible as they have a short length of eustachian tube (tube connecting throat and middle ear). Bottle feeding done with the toddler in a supine position, is another risk factor in children to develop this infection. Once these children develop a chronic middle ear infection, they are prone to develop complications unless treated adequately.The typical chronic ear ache along with pus discharge suggests chronic infection of the middle ear. Through an otoscope, inflammation of the middle ear and perforation of the tympanic membrane can be seen.  The microbes responsible for the infection can be identified by means of microscopic examination and culture of the pus discharge. Adequate course of a suitable antibiotic in form of tablets or local ear drops   helps in healing of the infection. Chronic and resistant infections need surgical intervention.One can prevent developing chronic infections of the ear, rather than suffering from   the resultant pain and discomfort. The ear should not be pricked in any way. Similarly it is important to keep the ears dry. While swimming or taking a shower ears should be plugged with cotton or covered  by other means like using a shower cap. Protection of the ears against droughts of cold or hot air also helps in avoiding inflammation and infection of middle ear.Steam inhalation done regularly is useful in curing symptoms of common cold. It also helps in preventing inflammation and congestion of the ear internally.Breast feeding as far as possible is healthy for children as compared to bottle feeding. If at all necessary to bottle feed, the baby should not be kept supine with head flat on the bed as this tends to cause ear infections. On experiencing any itching or pain with or without discharge in the ear, it is wise to consult and take adequate treatment before development of chronic infection.Dr Pande is a specialist-Internal medicine-Ruhengeri Hospital