Risk Factors for Middle Ear Infections
by Alayne Ronnenberg, ScD
A risk factor is something that increases your likelihood of getting a disease or condition.
It is possible to get an ear infection with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of getting an ear infection. If you have a number of risk factors, ask your healthcare provider what you can do to reduce your risk.
Age and Sex
Three-quarters of children will experience an ear infection before their third birthday, and nearly half of these children will have 3 or more infections by age 3. Although adults can get ear infections, children between the ages of 6 months and 6 years are the most prone to ear infections. The risk of ear infections is higher in children because their immune systems have less experience with common viruses than do those of adults. Virus infections likely are the direct or indirect cause of most middle ear infections. Moreover, children’s shorter and more level eustachian tubes (the eustachian tube is the small channel which lets air pass from the nose into the middle ear) make it easier for bacteria to gain access to the middle ear. Larger adenoids in some children also contribute to the development of ear infections. Boys are probably more likely to get otitis, especially chronic otitis media, than are girls.
Children in daycare or nursery schools are more likely to get ear infections because they are exposed to more upper respiratory infection s that can subsequently infect the middle ear. While daycare is necessary for many children, it is also one of the strongest risk factors for ear infection.
Exposure to Cigarette Smoke
Children who live with adults who smoke cigarettes are more likely to develop ear infections.
Children who are exposed to air pollutants are more likely to develop ear infections.
While ear infections are common in families from all levels of income, they tend to be more frequent and more prolonged in poor children. Poverty, daycare attendance, exposure to cigarette smoke at home, and young age are the 4 risk factors for ear infection which have been most consistently found in studies of this condition.
Children who are breast-fed, especially for 4-6 months or longer, have fewer and shorter ear infections than do bottle-fed infants.
Children are more likely to get an ear infection if they have a cold, sore throat, or perhaps some eye infections. Although ear infections are not themselves contagious, colds, sore throats, and other respiratory infections are readily passed from person to person.
Allergies and Asthma
People with allergies or asthma are more likely to develop ear infections. The reasons for this increased risk remain incompletely understood.
Children with immune disorders, including AIDS, and those receiving immunosuppressive therapy are more likely to develop ear infections because their bodies fight bacteria and viruses less effectively. The occurrence of an ear infection, or even multiple ear infections, is not itself an indication of AIDS or other immune disorder.
Medical conditions that cause abnormalities in the function or structure of the eustachian tubes, such as cleft palate, Down syndrome, or fetal alcohol syndrome, increase the risk of developing ear infections.
Drinking from a Bottle While Lying Down
Children who drink from a bottle while lying on their backs are more likely to develop ear infections, possibly because fluid is allowed to build up in the eustachian tubes.
Children who use pacifiers continually may be at greater risk for developing ear infections than children who use them less frequently or not at all.
A strong family history of ear infections, especially in older brothers or sisters, also increases risk.
Acute otitis media (AOM). EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated May 17, 2016. Accessed September 27, 2017.
Ear infections in children. National Institute on Deafness and Other Communication Disorders (NIDCD) website. Available at:
...(Click grey area to select URL)
Updated May 12, 2017. Accessed September 27, 2017.
Middle ear infections. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Middle-Ear-Infections.aspx. Updated February 22, 2013. Accessed September 27, 2017.
Last reviewed September 2018 by EBSCO Medical Review Board Marcie L. Sidman, MD
Last Updated: 9/17/2014
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