January 30th, 2019 by Sepehr Oliaei, MD

Cold and flu season often signals a peak in incidence of ear infections in children. I see children in our clinic frequently for this condition. In many cases these infections are viral and they resolve on their own or resolve with a short course of antibiotics. Children with ear infections that recur frequently, or persist on a more chronic basis are often referred to our clinic for consideration of temporary ear tube placement which can decrease frequency and severity of the infections.

I am often asked by parents if there are other means of reducing the risk of these infections and if there are things that predispose their children to this problem so I wanted to take some time to outline risk factors for recurrent and chronic middle ear infections in children to help educate parents.

Here is the list of things that affect the risk of ear infections in children:

  1. Nasal allergies are a significant risk factor. Indoor allergens and respiratory allergies contribute to the onset of infections. Allergies are prevalent in greater than 25% of children and are a major contributor to ear infections. Accurate diagnosis and adequate treatment of allergies can help reduce ear related sequela.
  2. Upper respiratory infection (URI), which includes the presence of cough or runny nose or sore throat, is a significant cause of the infections. Viruses, bacteria or both can be involved in these infections. Hence, use of antibiotics in some cases of ear infection.
  3. Snoring defined as the presence of loud snoring at least three times per week, is a common symptom in children. Early evaluation and intervention in children with loud snoring may prevent them from developing middle ear disease. Removal of enlarged adenoids may be one of the ways to improve ear function and snoring.
  4. Second-hand smoke has been reported to be associated with increased prevalence of middle ear disease. Several studies suggest that exposure to nicotine and other smoking products could make children more susceptible to ear infections and enhance the possibility of bacteria invading the middle ear by weakening body’s natural defenses against these organisms. Effective methods should be urgently taken to decrease the smoke exposure.
  5. Breast-feeding is believed to contribute to optimal defense against ear infections. It is reported that breast-feeding, even for only 3 months, could lessen the risk of middle ear infection in children.
  6. Day-care center attendance could increase the risk of children’s exposure to respiratory pathogens. It has been reported to be a significant risk factor for URIs in children
  7. Genetic predisposition is still under study but may explain prevalence of more ear infections in some families.


It is important to realize that each child, their medical condition and the influences on that medical condition be it an ear infection or otherwise are unique and statements above can not be generalized to every situation. Please consult with an ENT specialist near you for a personalized evaluation and treatment plan.


Sepehr Oliaei, MD

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