Ear infections: How many are too many?

The Pediatric Insider

© 2011 Roy Benaroch, MD

For November, I’m concentrating my writing chops on National Novel Writing Month. Fun! So I’m re-running revised versions of some classic posts. And by classic, I mean “old.” This one was originally from April, 2008. Enjoy!

What is a reasonable amount of ear infections a child should have in a year’s time span before parents should see an ENT or ask their pediatrician about tubes?”

There isn’t a one-size-fits-all answer, but I can tell you there are things that you and your doctor should look at that will influence this decision.

Factors that would encourage me to refer for tubes sooner:

  • Younger child. A child who’s six months old and has already had four ear infections is already in trouble.
  • Ear infections that always occur in both ears simultaneously. These affect hearing more.
  • Ear infections that need more than one course of antibiotics to cure.
  • Ear infections in a child with hearing problems or speech delays.
  • A child who has multiple antibiotic allergies, making ear infections harder to treat.
  • Ear infections that are occurring at the beginning of the winter. You do expect more ear infections through the cold season, so if you know you’re heading into a time with more ear infections, you should consider tubes more seriously.

Factors that lead me to watch-and-wait longer include many things that are the opposite of the above: an older child, or a child who only has one ear infected at a time, or a child who quickly responds to antibiotics. If it’s already the end of winter, I’m often temped to wait to see if ear infections continue in the warmer months before referring.

If you want to start with a number, I’d say that more than 5 ear infections a year is too many, and most children who are having this many ought to be at least considering visiting the ENT for tubes. The absolute number that means “tubes are necessary” depends on your child’s individual circumstances.

If your child is heading for “too many” ear infections, consider some other ways to prevent them. Ask yourself:

  • Can I take my child out of group care?
  • Is my child fully vaccinated (some vaccines protect against at least some ear infections, though not nearly 100%)
  • Is my child exposed to second-hand smoke?
  • Does my child have chronic nasal allergies that haven’t been treated?

Some kids are prone to ear infections, and sometimes tubes really are the best way to get off the one-antibiotic-after-another train. Review your child’s specific history with your pediatrician to see if it’s time to head to the ENT.

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12 Comments on “Ear infections: How many are too many?”

  1. Stacey Says:

    My three year old has had tubes and we are still having major problems. . Five ear infections by six months and they did tubes right away. . In the past two and a half years over twenty five ear infections, diagnosed by the head of the local childrens er, three pediatricians, and numerous urgent care doctors. However, my child ent insist that because the tubes are still in place and clear, that because there was not drainage, they were not ear infections. (i was always tolf there was puss behind the tubes) In fact he informed me he was going to re educate his colleges. Frustrating to watch your child run extremely high fevers, scream in pain and go through one antibiotic after the other and no one do anything about it but accuse the other doctors of not knowing what they are doing. . Advice please!!!


  2. Dr. Roy Says:

    Stacey, I am sorry you are frustrated. I think part of the problem may be in this sentence of yours: “…diagnosed by the head of the local childrens er, three pediatricians, and numerous urgent care doctors.” Why are you going to so many different doctors? Your child needs care in one place, by one pediatrician, who isn’t just going to try to fix the acute problem, but is going to address The Big Picture.

    Your ENT is correct, by the way. If your child has tubes that are wide open– and anyone can tell they are by looking– an ear infection will be accompanied by visible pus draining from the ear. There will also be very little fever and very little pain. Maybe once in hundred times something weird will happen, but not 25 times. Next time you suspect your child has an ear infection, bring him to his ENT. Something is not adding up. Best of luck!


  3. gabrielle Says:

    my son is 10 months old and had 2 ear infections 1st started in left then turned to a double ear infection he was giving amoxicillin he was allergic to that 4-6 days after this ear infection cleared he got another that started in his right with in 4-8 hours it turned into a double both time i had to rush him to ER cause his temp was over 104 and now he is screaming at night and holding his ear and i seen a ped. (that was his Ped. cause i was a walk-in and his doc wasnt there) said his ears were kinda pink but thats it. i dont know if i should take him to a ENT doc to get it checked out. Any advice you could give me would be much appreciated


  4. Dr. Roy Says:

    Gabrielle, without examining your child I really can’t give you any specific advice. if you’re not confident that your pediatrician is handling this well, of course seek a second opinion.


  5. pearl rodriguez Says:

    My son just turned one and has had 5 ear infections, he sees a ENT on january 12 is there
    other options other than tubes ?


  6. Dr. Roy Says:

    Pearl, almost all ear infections start with upper respiratory infections (the common cold). If your child can avoid some colds, he will avoid some ear infections, too. Take him out of day care, if possible, and eliminate second-hand smoke.

    There are some vaccinations that will prevent some (not all, and not most, but some) ear infections– make sure your son has had the routine series of “pneumococcal vaccine” and influenza vaccine.


  7. Karen Rivera Says:

    My Daughter is 5 years old and she has ear infections every 3 months. Her pedriatician send her to see a ENT. The ENT suggested surgery plus tubs. Her Pediatrician said that every 3 months is not too bad. Advice please.


  8. sara Says:

    my daughter will be 2 on the 10th september 2012.she has had 10 ear infections and 13 antibiotics.the ENT will not give her tubes as her hearing is perfect BUT she still cant walk. I am back with ENT on the 18th and i will demand tubes. i am so frustrated! if anyone has any ideas to ensure tubes are given id love to hear from you


  9. asia jett Says:

    my Daughter is a year and six mths and she had tubes and her ears on aug 23 and every since then she had five ear infection im so scared that all the ear infection she had will mess up her hearing. i would love to hear for someone about this


  10. Uzzy Says:

    I am 26 and have had do many about 8in the past year and coz I only went to the docs for four of them they say its not enough to be referred !! My ears leak all the time too


  11. Erica Says:

    My three year old has had three sever ear infections in a month and half. He’s been on three differnt antibiotics. DX by his Ped.
    No one has mentioned tubes or anything.


  12. Melanie Says:

    My daughter is almost 3yrs old. She has language delay cause of autism. She has had ear infections in both ears for 8 weeks only 1 of these weeks shes gone with no antibiotics. shes also has a throat infection in this time period too. She doesnt go to a day care an we have a smoke free home. My daughter is now on a 2 week course of antibiotics and shes had 4 diff types. She has now been referred to ENT 🙂 shes had hearing checked cause of her language delay, she dont have glue ear.


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