Recurrent Otitis Media

Recurrent otitis media, the medical term for recurrent middle ear infections, plagues many children in the United States. Two-thirds of American children have had an acute ear infection by two years of age; and chronic ear infections affect two-thirds of children under the age of six.

Recurrent otitis media, or otitis media with effusion, occurs when fluid in the middle ear is unable to properly drain into the back of the throat through the Eustachian tube. The result is a build-up of fluid in the middle ear, which can cause hearing problems or can provide a perfect environment for the growth of viruses, bacteria and fungi, which can lead to more severe infection.

Fortunately, some minor dietary changes may be able to help with this condition and may even prevent future episodes of otitis media.


Eliminate common food allergens including milk and dairy products, eggs, wheat, corn, oranges, peanuts and concentrated sources of sugar.

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Food Sensitivities
Allergy Avoidance Diet


What Is Recurrent Otitis Media

Otitis media, or middle ear infection, is by far one of the most common illnesses in children today. It's estimated to account for as many as one-third of all pediatrician visits.

Research studies have shown that anywhere from 25-85% of children have had at least one episode of ear infection by the age of six months, and anywhere from 50-97% have had one by the age of one year, depending on the group studied. In 1986, around 20 million courses of antibiotics were prescribed for otitis media alone.

Recurrent otitis media or severe otitis media with effusion can lead to problems with hearing or hearing loss. If this occurs at certain stages of a child's life, it may interfere with language and speech development. The good news is that there may be ways to protect your child from this condition.


Some children with middle ear infections may not show any symptoms at all. For these children, the otitis media may be noticed for the first time at a routine well-child exam. For others, especially when the infection is bacterial, fungal, or viral, the symptoms can be quite severe.

Unfortunately, most infants and toddlers can't tell us exactly what they're feeling, so here are some signs to look for to indicate that your child may have otitis media:

  • Crying more than usual
  • Tugging or pulling at the ears
  • Playing with the ears or sticking things into the ears
  • Fever
  • Hitting the sides of the head
  • Difficulties hearing sounds that other people hear
  • Troubles with speaking or a failure to try to speak

The two main conventional treatments currently used for otitis media include antibiotics and ear tubes. Antibiotics are often prescribed for ear infections, though there are doubts as to whether the antibiotics taken by mouth ever make it to the middle ear to do any good. Some doctors even prescribe low doses for a long period of time to try to prevent infections.

Unfortunately, antibiotics can have negative side effects, like killing the beneficial bacteria that live in our intestines, or diaper rash. Also, with the rising number of dangerous, antibiotic-resistant bacteria now on the scene, doctors are being urged to only prescribe antibiotics in severe cases and to stop prescribing antibiotics so frequently for milder cases. Sometimes doctors prescribe an antibiotic just because they think that that is what the parent wants.

If your doctor prescribes antibiotics, you may want to discuss whether they're absolutely necessary or if there are other treatment options available. In acute cases, antibiotic ear drops may be safer and more effective than oral antibiotics.

Ear tubes are also used for recurring otitis media. While they can be helpful in severe cases to prevent hearing loss and problems with language development, they may not be helpful for less severe cases. Some studies have shown that children with ear tubes may get more infections than those without. Again, if your doctor recommends ear tubes, discuss with him or her whether they are absolutely necessary.

The Disease Process

What is happening inside those little ears to cause so many problems? Well, it may not be your child's ears that are the source of the problem after all.

The normal ear has three main parts: the inner ear, the middle ear, and the external ear. The inner ear is deepest inside the head and is mostly responsible for balance and equilibrium. Infections rarely occur here, but when they do the symptoms are severe, including dizziness, ringing in the ears, nausea, and even vomiting.

The outer ear is the part that you see on the outside and also the ear canal. This part is mainly responsible for funneling sound into the ear and also protecting the rest of the ear from dirt or infectious agents. Swimmer's ear is a type of infection of the outer ear.

The middle ear, as the name implies, lies between these two inner and outer portions. It is separated from the ear canal by the tympanic membrane, or ear drum, and is mostly responsible for hearing. Special cells in the middle ear produce a fluid that keeps the middle ear moist and functioning properly. Normally, excess amounts of this fluid drain down the Eustachian tube to the back of the throat. Normally, the Eustachian tube opens 3-4 times a minute with regular breathing and swallowing.

In some people, however, the Eustachian tube does not open regularly as it should. When the tube fails to open, fluid cannot drain out of the middle ear, so it builds up. This build-up of fluid is referred to as otitis media with effusion. The fluid can interfere with the mechanisms of hearing in the middle ear, resulting in hearing loss. Since the development of spoken language depends on hearing, such hearing loss may result in problems with the learning of language in some children if the effusion is bad enough at just the wrong time.

Another problem that can develop is called acute otitis media. The fluid in the middle ear is moist and warm. If bacteria or viruses or fungi make their way into the middle ear, they may start to grow there, causing a full-blown infection.

The problem in the middle ear is mainly caused by problems with the opening of the Eustachian tube, which is in the back of the throat. The main cause of Eustachian tube problems is inflammation in the tube or back of the throat. When inflammation occurs, the area around the tube's opening gets swollen, which causes the tube to squeeze shut and prevents it from opening properly. Sometimes the inflammation can even travel up the tube and reach the middle ear, where it causes the special cells to produce even more fluid, further adding to the problem.


Researchers believe that the main cause of this inflammation is allergies, either to environmental factors such as mold, pollen, or dust, or to certain foods. When people who are allergic to a substance, pollen for example, are exposed to it, the cells of their immune system overreact and start to produce antibodies and pro-inflammatory chemicals to try to attack this substance.

While this is a protective response against a harmful virus or bacteria that is trying to invade the body, when it occurs in response to something fairly harmless, like pollen, it is more of a nuisance than anything else. This overreaction leads to symptoms of allergies, like sneezing, runny nose, itchy eyes, and cough. Unfortunately, for as many as 22-83% of children and adults with allergies, this inflammatory response also leads to recurrent otitis media.

Dietary Causes

One of the main dietary causes of recurrent otitis media is food allergies. For some reason, certain people tend to react to certain foods, which can lead to inflammation and fluid build-up in the middle ear. Some studies show that more than half of recurrent otitis media sufferers react to foods. When these foods are taken out of their diets, the otitis media with effusion goes away, and they become ear infection-free.

The most common food to which the vast majority of people react is cow's milk and other dairy products. Certain proteins in cow's milk trigger the immune systems in some people to overreact, leading to inflammation. These proteins are found in milk, cheese, yogurt, many baked goods, non-Kosher lunchmeats, some "non-dairy" creamers and whipped toppings, certain medications, and even cow-based infant formulas.

Other foods that have been shown to cause reactions include wheat, corn, eggs, potatoes, sugar, oranges, artificial colorings, preservatives, and additives. Although any food can be the inflammatory trigger for an individual, foods that are frequently eaten should be prime suspects. Following an allergen avoidance diet or keeping track of symptoms and foods in a diary can help to identify offending foods.

Another factor that seems to contribute to ear infections is not being breastfed. Children who are either not breastfed or breastfed for less than three or four months tend to have a much higher risk for ear infections than children who are breastfed or who are given breast milk as a source of food.

This is because breast milk not only contains several substances that are necessary for the healthy development of a child's immune system, but also provides substances that protect infants, whose immune systems are still developing, against infections.

Still another possible cause of ear infections is feeding position. When an infant drinks from a bottle while he or she is lying down, some of the fluid may actually travel up the Eustachian tube. This can lead to irritation and inflammation in the tube, which can then lead to an ear infection. Studies have shown that children who are given a bottle to take to bed are at increased risk for ear infections. Infants should therefore be in a slightly sitting-up position whenever they are drinking.

Nutrient Needs

Breast Milk

Though it is probably too late for many children who are currently suffering from recurrent ear infections, breastfeeding can significantly reduce the risk for ear infections in children. In addition to the perfect blend of protein, calories, and nutrients for growing babies, breast milk contains substances, including antibodies, that help infants fight off infections. These and other components in breast milk also help encourage the healthy development of the baby's immune system.

Infants who are breast fed have fewer ear infections as well as less risk of developing some other conditions, such as allergies and asthma. Researchers have found that babies must be breast fed for at least four months to really have a protective effect against ear infections.

Other Nutrients

Vitamin C, zinc, and vitamin A have all been identified as being vitally important for the proper function of the immune system. They're needed by the immune system to fight off harmful bacteria, viruses, and fungi, and they also help to keep the immune system balanced to prevent excess inflammation. People who are deficient or low in any of these nutrients tend to have more infections and illness than people who get healthy amounts of them in their diets.

Although they have been shown to be helpful in other illnesses, these nutrients have not been studied for their direct impact in preventing recurrent ear infections. Perhaps future research will demonstrate their beneficial effects in this condition.

Nutrient Excesses

Substances to Avoid

Food Allergens

Food allergies can be a major component of this condition for many sufferers, with dairy being the most common allergenic food. Certain components of certain foods trigger the immune system in some people, causing inflammation that can lead to ear problems. Many patients find that when the offending foods are eliminated from their diets, their ear infections go away and don't return. Following an allergy avoidance diet or keeping a symptom and food diary for a little while can help people identify if food allergies are causing them problems.


Studies have shown that the consumption of 100 g (3 ounces) of sugar in one sitting depresses immune function by 50% for up to 5 hours. In addition to refined white sugar, corn syrup, honey, dried fruit, undiluted fruit juice, soft drinks, baked goods, sweetened cereals, candy, ice cream, other sugar-laden products should be avoided.

Turning off the immune system, even just temporarily, can leave us open to attack by viruses and bacteria. Removing refined, sugary foods from the diet can help reduce the chances of getting an infection, possibly even ear infections.

Recommended Diet

The best place to start in the prevention of recurrent otitis media is at birth. Breast feeding is the way to provide your baby with the best nutrition available.

Current guidelines from leading pediatric groups are that children should receive nothing but breast milk for the first six months of life. After six months, foods should be introduced, but the breast feeding should continue until at least one year of age. Some groups recommend breast feeding for at least two years, with the worldwide average being four years.

For babies who are unable to nurse, getting breast milk that has been pumped from their mothers or from a milk donation bank has also been shown to have a beneficial impact.

For some children, cow's milk is the source of their ear problems. Fortunately, there are ways to get all of the nutrients needed without drinking cow's milk. Some people even find that they can tolerate goat's milk better than cow's milk.

In addition, many different types of milk substitutes are currently available, from soy to rice to almond to oat drinks, etc. Some of these are even enriched with the same amounts of calcium and vitamin D that you would get from regular milk, without any of the harmful saturated fat or cholesterol. Unfortunately, some of these milk alternatives may have added sugars or sweeteners, which can knock down the immune system, making your child even more susceptible to infections.

Also, some children may develop allergies to soy or some of these other alternatives, so keep an eye on your child and if he or she starts to have problems again, try a different beverage. Or you can try giving your child some fresh, clean water to drink and increasing their protein intake with other foods, such as beans, lentils, whole grains, or organic meats. Many vegetables are rich in the calcium that they would get from milk. A good, whole foods diet can replace the cow's milk in their diets and get them on the road to a healthy lifestyle.

Infants under the age of 1 year should not just be given dairy substitutes. They need the extra nutrition that can typically only be found in special infant formulas. Sometimes goat milk can be used, but certain important nutrients must be added to it first.

If your infant has problems with dairy, discuss alternative formula choices with your pediatrician. Soy-based formulas may be a safer alternative, but some children can be allergic to soy as well, so you need to watch for that. Hydrolyzed formulas, although frequently derived from cow's milk, are pre-digested, making them much better tolerated than cow's milk for some infants. Hydrolyzed formulas are, however, more expensive.

Your pediatrician may have a recipe for home-made formula using goat's milk or almond, oat, or rice beverage to which you will need to add additional nutrients. Such formulas take a little time to prepare, but cost less than hydrolyzed formulas while providing excellent nutrition for your baby.

And pass on the sweet artificially flavored "fruit" drinks, the cookies, ice cream, and candy bars. Sugary treats do not treat your child's immune system well, suppressing its ability to protect him or her from invasion by harmful bacteria or viruses.

Instead reach for some naturally sweet fresh fruit, lightly roasted nuts or crunchy vegetables. Try some all fruit popsicles instead of the artificially flavored sugar-water varieties. For a creamy, hot dessert, try baked apples stuffed with raisins and walnuts and cooled with vanilla-flavored soy milk. These treats contain a variety of nutrients, including vitamin C and zinc, which can give your child's immune system the added boost it needs to keep your child healthy.

In general, a diet rich in healthy, whole foods is going to be best for improving your child's defenses and reducing risk of infections. Fresh fruits, vegetables, whole grains, legumes, and lean meats or fish will supply your child with plenty of important nutrients that can keep the body working properly and safe from infections.

The Condition Specific Meal Planner for Recurrent Otitis Media has menus that cover the nutritional needs of this condition over a four day period.


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This page was updated on: 2004-11-21 15:57:01
© 2002 The George Mateljan Foundation