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Preventing middle ear infections

Last Update: December 1, 2016; Next update: 2019.

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 some things that might be able to lower the risk of middle ear infections somewhat. But it is usually not possible to prevent them completely.

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. There is a lack of scientific evidence for the benefit of many things recommended to prevent middle ear infections. If a child has a middle ear infection, it is important to relieve symptoms using an appropriate treatment and to watch for possible complications.

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 explanation for this is that sucking on a pacifier could change the pressure in the throat and ears. Infections can also be spread through the use of pacifiers. But it is unclear whether using a pacifier less – for example, only when falling asleep – makes a difference.

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 flu virus infections and lower the chances of developing a middle ear infection. Researchers have also observed that children who have been vaccinated are less likely to need antibiotics. But the German Standing Committee on Vaccination only recommends an annual flu shot for children, teenagers and adults 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 is not clear whether this is a realistic option for most children, and it may not be worth the trouble. Most of the children did not benefit from chewing the gum: middle ear infections were prevented in 1 out of 10 children who chewed xylitol gum five times a day for three months.


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. But 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.

Tonsil surgery and the use of ear tubes

Enlarged tonsils 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 tonsillectomy (surgery to remove the tonsils) or the use of ear tubes could prevent middle ear infections. These two procedures are sometimes done together.

Although tonsillectomy on its own probably can't prevent middle ear infections, the use of ear plugs did make children less likely to have further middle ear infections. This may also depend on whether the child has chronic glue ear.

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


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