Everything You Need to Know About Recurrent Ear Infections

Chronic Otitis Media
Recurrent Ear Infections. Stockbyte / Getty Images

What are Recurrent Ear Infections?

The American Academy of Pediatrics defines recurrent ear infections (otitis media) as 3 or more episodes of acute otitis media (AOM) in a 6 month period or 4 or more episodes of AOM in a year.

What Causes Recurrent Ear Infections?

Ear infections occur when the auditory tube becomes blocked with mucous, enlarged tissue or other substances and is unable to drain. When the auditory tube is unable to drain air is also unable to reach the ears.

Negative pressure may draw fluid into the ears. These conditions are ideal for germs to grow in and an infection may occur.

Children are more likely to get middle ear infections than adults because their auditory tube is smaller and at a more horizontal angle, making it easier for the auditory tube to become blocked. Recurrent ear infections may occur as the result of a particularly difficult to cure infection that is resistant to antibiotics, or other conditions that make an individual more likely to develop frequent ear infections. The following conditions are known to increase your risk of developing recurrent ear infections:

  • cigarette smoke exposure
  • younger than age 2
  • males more likely to have recurrence than females

Prevention and Treatment of Recurrent Ear Infections

Lifestyle changes can make a big difference when it comes to recurrent ear infections. Keep in mind that most ear infections are the result of a cold virus or upper respiratory infection so practicing good hygiene such as frequent hand washing, covering your mouth when sneezing or coughing, and staying away from individuals who are ill can prevent ear infections.

There is also evidence that the following lifestyle changes may prevent ear infections:

  • eliminating exposure to tobacco smoke
  • keeping your child up-to-date on immunizations including the annual flu shot
  • Have allergies properly diagnosed and treated.
  • There is some evidence that exclusive breastfeeding through age 6 months reduces ear infections.
  • Some studies have suggested that pacifier use and bottle propping increase your baby's risk of developing ear infections.

Xylitol is a sugar alcohol that can be extracted from birch trees, some fruits, corn husks, or sugar cane. It is used as a low calorie sweetener and is available in chewing gum, lozenges and syrup. Studies have shown that xylitol can significantly reduce the incidence of ear infections. Research has also shown xylitol to have a positive effect on dental health, it may reduce cavities and re-mineralize damaged tooth enamel. Despite these exciting findings, xylitol is not ideal for preventing ear infections in children under the age of two who cannot chew gum or suck on lozenges. This is due to the fact that the syrup form of xylitol had the weakest effects in studies and must be given 3-5 times a day every day during the respiratory season to be effective in preventing ear infections. In the future, however, xylitol, may become available in other forms such as ear drops or nasal sprays which could be beneficial in preventing ear infections.

Long term antibiotic use to prevent ear infections may be beneficial for some person's who experience frequent ear infections. Studies have shown that using antibiotics in this manner reduced recurrent ear infections by about half. However, these benefits must be weighed against negative side effects with antibiotic use such as diarrhea and the potential for allergic reactions and the development of antibiotic resistance.

The surgical placement of ventilation tubes (tympanostomy tubes) is a common treatment for recurrent ear infections. A small hole is made in the ear drum and a synthetic tube is placed inside of the auditory tube. This synthetic tube holds the auditory tube open so that it can drain and allows proper ventilation to occur. The procedure is performed under anesthesia. However, research on the benefits of this treatment without fluid present in the ears is lacking. Some studies have shown significant improvements in the quality of life and decreased number of infections in children who had ventilation tubes placed for recurrent ear infections while others showed no benefit. While there are few risks associated with the procedure itself, there are always risks when undergoing general anesthesia and these must be considered.

Enlarged adenoids may in some cases prevent the auditory tube from draining properly. While removing enlarged adenoids in addition to the placement of ventilation tubes may be beneficial in reducing ear infections, adenoidectomy alone is not recommended.

Long Term Effects of Recurrent Ear Infections

If a middle ear infection goes untreated for a long enough period of time damage to the ear can occur. The following conditions have been associated with chronic ear infections:

Rarely, if the infection goes on long enough it can lead to serious conditions such as:

  • damage to the facial nerve resulting in facial drooping or weakness
  • damage to the mastoid process
  • meningitis
  • cholesteatoma
  • brain abscess

While in most cases it takes years of chronic ear infections for these kind of problems to occur in some cases significant damage to the inner ear and surrounding structures has occurred over a period of months. Even though these effects are rare they emphasize the importance of getting proper medical treatment for recurrent ear infections.


American Academy of Pediatrics. The Diagnosis and Management of Acute Otitis Media. Clinical Practice Guidelines. Accessed: October 29, 2013 from http://pediatrics.aappublications.org/content/131/3/e964.full?sid=9cdf466d-8e53-496b-9c5e-a2aa52b0a850#sec-68

University of Maryland Medical Center. Chronic Otitis Media. Accessed: October 29, 2013 from http://umm.edu/programs/hearing/services/ear-infections

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