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How can middle ear infections in children be prevented?

Created: ; Last Update: May 9, 2019; Next update: 2022.

Parents might wonder what they can do to help prevent painful middle ear infections, especially if their children have them again and again. There are a few things you can do that might lower the risk a little.

Babies' and toddlers' immune systems are still maturing – it will still take some time before they are better at fighting off disease. So colds and middle ear infections are a normal part of a child's development. If a child has a middle ear infection, it's important to relieve the symptoms using an appropriate treatment and to watch for possible complications.

There are various things that are recommended for the prevention of middle ear infections. But it's not clear how much they help: There aren’t any good scientific studies in this area.

Smoke-free environment

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


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. So it's worth trying to let your child use a pacifier less frequently – for example, only to help them get to sleep.

Pneumococcal vaccination

Babies who are vaccinated against pneumococcal infection are somewhat less likely to have a middle ear infection. Vaccination probably can't prevent middle ear infections in children who have already had it several times, though. This vaccination will only offer protection from infections that are caused by pneumococcus bacteria. But middle ear infections can also be caused by other bacteria or viruses. The pneumococcal vaccination is recommended by the German Standing Committee on Vaccination (STIKO). They advise parents to have their children vaccinated three times between the ages of 2 and 14 months.

Flu vaccinations

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 gum

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 or take syrup containing xylitol. Chewing gum is more effective than syrup.

But the chewing gum only had a preventive effect if it was chewed five times a day for several months. The gum had no effect if the children only chewed it three times a day. It's not clear whether this is a practical option, and it may not be worth the trouble.


The trace element zinc is vital for the immune system to function optimally and successfully fight off infections. A typical diet will usually supply your body with all the zinc it needs. Pharmacies and drugstores also offer zinc in the form of dietary supplements, some of which are meant to strengthen the immune system.

Studies found no evidence that zinc supplements can prevent middle ear infections in children who eat a balanced diet. But zinc can help prevent middle ear infections in children who have severe malnutrition, for example in developing countries.

Adenoid surgery and the use of ear tubes

Enlarged adenoids can prevent the flow of air to and from the middle ear and increase the chances of a middle ear infection developing. Some studies looked at whether adenoidectomy (surgery to remove the adenoids) or the use of ear tubes could prevent middle ear infections. These two procedures are sometimes done together.

Although adenoidectomy on its own probably can't prevent middle ear infections, the use of ear tubes may lower the risk of developing another middle ear infection. This may also depend on whether the child has chronic glue ear.

When deciding whether or not to have surgery, it's important to consider that the procedure can have side effects. Middle ear infections become less common as children grow older anyway.


© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK279382


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