Middle ear infections are common in young children and can happen more than once. The research reviewed by IQWiG describes measures that may reduce the risk, although infections cannot always be prevented.
What helps
A smoke-free home. Secondhand smoke increases the risk of airway and throat infections. Keeping the home smoke-free may help reduce infection risk.
The pneumococcal vaccine. Vaccinated babies have somewhat fewer ear infections, but protection is limited to pneumococcal bacteria. Other bacteria and viruses can also cause ear infections. The vaccine probably does not prevent repeated ear infections in children who have already had several. Follow your local vaccination schedule.
What might help
Pacifier use. Frequent use is linked to a slightly higher risk of middle ear infections. The source suggests that reducing use may help. Discuss pacifier use with your child’s clinician.
The flu shot. Fewer flu infections may mean fewer ear infections, and vaccinated children in studies needed antibiotics less often. Whether it's routinely recommended for healthy children varies by country, so this one is a conversation with your pediatrician.
Xylitol and the limits of the evidence. Studies found a preventive effect only with frequent use over several months. These results do not establish a practical plan for an individual toddler. Younger children may have difficulty using chewing gum.
What doesn't seem to help
Zinc supplements. Zinc matters for immunity, but a normal diet already provides enough. Studies found no preventive benefit for well-nourished children, the exception being children with severe malnutrition.
If infections keep coming back
Repeated infections. Removing enlarged adenoids alone probably does not prevent further infections. Ear tubes may help in some situations, but surgery has risks. Ear infections also become less common as children grow. Discuss the options with your child’s clinician.
Sources
The original InformedHealth.org article draws on these studies and reviews:
- Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev 2016; (8): CD007095.
- De Sevaux JL, Venekamp RP, Lutje V et al. Pneumococcal conjugate vaccines for preventing acute otitis media in children. Cochrane Database Syst Rev 2020; (11): CD001480.
- Gulani A, Sachdev HS. Zinc supplements for preventing otitis media. Cochrane Database Syst Rev 2014; (6): CD006639.
- Norhayati MN, Ho JJ, Azman MY. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev 2017; (10): CD010089.
- Steele D, Adam GP, Di M et al. Tympanostomy Tubes in Children with Otitis Media. (AHRQ Comparative Effectiveness Reviews; No. 185). 2017.
- Venekamp RP, Mick P, Schilder AG et al. Grommets (ventilation tubes) for recurrent acute otitis media in children. Cochrane Database Syst Rev 2018; (5): CD012017.
