How can middle ear infections in children be prevented?

It is particularly important to make sure that children grow up in as smoke-free an environment as possible. Passive smoking increases the risk of infections in the airways, as well as in the upper throat. It also weakens the child's immune system.

Babies and toddlers who regularly use a pacifier (dummy) are a little more likely to develop middle ear infections. One possible explanation for this is that sucking on a pacifier changes the pressure in the throat and ears. Infections can also be spread through the use of pacifiers. That's why giving a child a pacifier less often – for example, only when putting them to sleep – could slightly reduce the risk.

Babies who are vaccinated against pneumococcal infection are somewhat less likely to have a middle ear infection. This vaccination will only offer protection from infections that were caused by pneumococcus bacteria. But middle ear infections can also be caused by other bacteria or viruses. The pneumococcal vaccine is recommended by the German Standing Committee on Vaccination (STIKO) to prevent serious infections such as pneumonia and meningitis. They advise parents to have their children vaccinated three times between the ages of 2 and 14 months.

Vaccination probably can't prevent middle ear infections in children who have already had it several times.

Flu vaccinations can prevent infections caused by flu viruses. They may also lower the risk of middle ear infections. Researchers have also observed that children who have had flu vaccinations are less likely to need antibiotics. But the German Standing Committee on Vaccination only recommends an annual flu shot for children who have a higher risk of developing serious flu complications – for instance, people who have respiratory, heart or metabolic disease.

Xylitol is a naturally occurring sweetener found in foods like strawberries, raspberries and plums. It is used in sugar-free chewing gum. Xylitol can slow the growth of some types of bacteria, including those that can cause middle ear infections. Research suggests that children who go to daycare will develop fewer middle ear infections if they regularly chew xylitol gum.

But the chewing gum only had a preventive effect if it was chewed five times a day for several months. It had no effect if the children only chewed it three times a day. It is not clear whether this is a practical option because younger children often have trouble with chewing gum.

Probiotics contain live microorganisms, such as lactic acid bacteria, that have been specially developed in a laboratory. They are said to have a beneficial effect on the gut flora and to strengthen the immune system. Probiotics are available in tablet or drink form. In studies, children developed middle ear infections and other respiratory infections slightly less often when they took probiotic products daily. But they were unable to reduce the risk of recurring middle ear infections. And they didn't need to use fewer antibiotics either. It is also unclear exactly which products are effective, and it is questionable whether the effort involved (costs, daily use) is worth it.

If a middle ear infection causes the mucous membranes to swell up and release fluid, the tympanic cavity fills up with the fluid. This is called otitis media with effusion or "glue ear." It usually goes away after a few days or weeks, but in some children it remains and causes hearing problems. This can slow the development of speech in small children. Glue ear also increases the risk of middle ear infections that keep coming back.

When a child has persistent glue ear it's best to wait a few months to see if it clears up on its own. The child's ears should be checked regularly in the meantime. If it doesn't go away, doctors often recommend inserting an ear tube into the eardrum. An ear tube is a narrow tube made out of plastic or metal that allows air to flow to and from the middle ear. An ear tube is normally inserted while the child is under general anesthetic, and it usually falls out of the ear on its own after about six to twelve months.

Ear tubes reduce the risk of new infections. They can relieve glue ear quickly and improve hearing in the first few months. But there is no proof that they can provide long-term improvement and help to prevent problems with speech and language development. Middle ear infections become less common as children grow older anyway.

There usually aren't any complications during the procedure. Possible risks include infection or a tube slipping into the tympanic cavity. In rare cases hearing problems may develop after the procedure if the incision doesn't heal after the treatment or if there is scarring on the ear drum.

Enlarged adenoids can also prevent the flow of air to and from the middle ear and increase the risk of a middle ear infection developing. So they are sometimes removed. The procedure can be combined with the insertion of an ear tube.

Adenoidectomy on its own probably can't prevent middle ear infections,