Ear Infections, Antibiotics, and What's Actually Driving the Pattern

Most children with ear infections are given antibiotics. Most don't need them. This episode explains what's actually going on and what you can do about it.

Ear infections are the single most common reason children receive antibiotics worldwide, and yet most parents are never told that the majority of uncomplicated cases resolve without them. This is not an anti-antibiotic conversation. It's about understanding what's actually driving the pattern, knowing when antibiotics are actually indicated, and what you can do in the meantime.

I had recurrent ear infections as a child. Multiple rounds of antibiotics, back to back, and never grommets (no idea why!). So this is a topic I came to with personal history as well as 15+ years of clinical experience, and one I see regularly in clinic with families who feel like they're going around in circles and don't know why.

This week's question is the first that comes from a listener who isn't a friend or family member, which I'm not even a little bit quiet about being excited by. And my recco is for Newcastle and Hunter Valley locals, a farm delivering grass-fed, grass-finished beef that I cannot recommend highly enough.

In this episode:

• Why children are anatomically prone to ear infections and why most grow out of it

• The role of the adenoids, tongue ties, and the Eustachian tube

• The internationally recommended first-line approach for uncomplicated ear infections in children over 6 months

• Red flags that indicate antibiotics are indicated

• The gut-ear axis and why recurrent antibiotic use can drive recurrent infections

• Food sensitivities as a driver, particularly dairy, and what an elimination diet actually involves

• What to do acutely to support your child's comfort

• Lifestyle factors including feeding position, dummy use, nose blowing, chewing, and hand hygiene

• Osteopathic assessment, when and why to consider it

• Supplements with the most evidence

Antibiotic red flags - always seek medical assessment if:

• Your child is under 6 months of age

• Your child has infections in both ears and is under 2 years

• Fever is 39 degrees or above

• Severe ear pain has lasted more than 48 hours

• There is discharge from the ear

• There is no improvement after 72 hours of watchful waiting

• You notice facial swelling, unusual irritability, or any sign of deterioration

If you are ever unsure, seek assessment from your GP. NSW residents can also call Healthdirect on 1800 022 222.

Links mentioned:

• ⁠In My Clinical Opinion - paediatric⁠

• ⁠Book a 1:1 consult⁠

• ⁠Submit a question or topic⁠

• ⁠Allynview Farm⁠

• NSW Healthdirect: 1800 022 222

• Silicon chewing device like ⁠Myo Munchee

References:

1. Nsouli TM et al. Role of food allergy in serous otitis media. Annals of Allergy. 1994;73(3):215-219.

2. Cardenas-Escalante P et al. Otitis media, probiotics, and dietary patterns in children, systematic review. Nutrients (2024/25).

3. StatPearls: Anatomy, Head and Neck, Ear Eustachian Tube. NCBI Bookshelf.

4. Boronat-Toscano M et al. The Eustachian Tube Dysfunction in Children. PMC (2022).

5. Is Allergic Rhinitis Related to Otitis Media with Effusion? Comprehensive review. Cells (2025).

6. Juntti H et al. Cow's milk allergy is associated with recurrent otitis media during childhood. Acta Otolaryngologica. 1999.

7. Effects of the Traditional Mediterranean Diet in Patients with Otitis Media with Effusion. PMC (2021).

8. Aakko J et al. Gut probiotic metabolites in prevention and treatment of otitis media. Frontiers (2025).

9. Bosch AATM et al. Development of upper respiratory tract microbiota in infancy is related to lower respiratory tract infection risk. Cell Host and Microbe (2017).

10. Hatakka K et al. Effect of long term consumption of probiotic milk on infections in children attending day care centres. BMJ (2001).

11. American Academy of Pediatrics. Clinical Practice Guideline: The Diagnosis and Management of Acute Otitis Media. Pediatrics (2013, updated 2022).

12. Azarpazhooh A et al. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database of Systematic Reviews (2011).

13. Marchisio P et al. Vitamin D supplementation reduces the risk of acute otitis media in otitis-prone children. Pediatric Infectious Disease Journal. 2013;32(10):1055-60.

14. Cayir A et al. Serum vitamin D levels in children with recurrent otitis media. European Archives of Otorhinolaryngology (2014).

15. Sarrell EM et al. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Archives of Pediatrics and Adolescent Medicine. 2001;155(7):796-799.

16. Riede L et al. Larch arabinogalactan effects on reducing incidence of upper respiratory infections. Current Medical Research and Opinion. 2013;29(3):251-258.

17. Dion C et al. Does larch arabinogalactan enhance immune function? Nutrition and Metabolism (2016).

18. Jones LL et al. Parental smoking and the risk of middle ear disease in children. Archives of Pediatrics and Adolescent Medicine (2012).

19. Scoping review on osteopathic manipulative treatment for paediatric otitis media. European Archives of Otorhinolaryngology (2025).

This episode is for educational purposes and does not replace individualised medical or naturopathic advice. Always seek assessment from a qualified health professional for your child's specific situation.

New here? Find me on Instagram (@kate__holm) or at kateholm.com. Thanks for listening!