Ear infections are one of the most common ailments of young children.  Unfortunately, babies (birth to two years old) are anatomically at a disadvantage for ear infections, due to their flat eustachian tubes. According to the American Speech-Language Hearing Association (ASHA), children who have more than 2 ear infections before their second birthday should be evaluated by an audiologist.



What are the causes of ear infections?

It is normal for the inner ear to have a small amount of fluid. This helps us to maintain balance and equilibrium in our environment.  When this fluid becomes infected, however, it can lead to an ear infection.  The most common cause is a virus.  A young child’s anatomy lends to mouth breathing, and many infections enter through the open mouth, where it has direct access to the eustachian tube, and thus the ear.

A second, less familiar, cause of ear infections is reflux.  Many people think of gastroesophageal reflux (GERD), which is that all too familiar feeling of heartburn.  However, laryngopharyngeal reflux (LPR), is actually a much more dangerous condition. When undiagnosed and/or untreated, this condition can be the lead cause of recurrent ear infections.  Basically, what happens, is reflux from the larynx (throat) backs up into the mouth and enters the child’s eustachian tube.  So, you can treat the child with antibiotics, but a few weeks later, the condition will re-occur.

Other possible contributors to ear infections are enlarged tonsils or adenoids, which cause increased mouth breathing and increased chances for exposure to viruses.

Who should I see about ear infections and reflux?

When your child shows the first signs of ear infection, the first stop should always be your pediatrician.  Typically, ear infections are treated with a course of antibiotics and your child will be out of pain within the next 48 hours.

What if ear infections persist?

In the case of recurrent ear infections,  you should find a referral for a pediatric ENT, who is trained to look directly at your child’s throat for signs of reflux.  At this point, the reflux would be treated, and you will hopefully see a reduction in ear infections.

If the ear infections do not resolve, your child may be a candidate for pressure equalizing tubes (PE tubes), which “protect” the ear from future infections.

An often overlooked appointment is with an audiologist.  An audiologist should be seen after each occurrence of ear infection to see if there has been any damage to your child’s hearing mechanism.  The audiologist will not only test hearing acuity (how well your child can hear at different volumes) but will also check for fluid in the ear.

When should you contact a speech-language pathologist?

I liken having an ear infection to listening to someone speaking while your head is underwater.  This can have a profound effect on your child’s language learning abilities at a critical age.  If your child has had 2 or more ear infections before their second birthday, or if you have seen a regression in your child’s speech and language development, you should contact a speech-language pathologist.


Do you have experience with recurrent ear infections, infant reflux, or tube placement? I would love to hear about your experiences.