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ACAAI > Patients & Public > Resources > Ask the Allergist

Little Ears, Big Infections

Q: My toddler son has had numerous ear infections that started around 6 months of age. Why does my son get so many ear infections, and what can be done to evaluate and treat them?

A: Nasal inflammation and congestion spread easily to the middle ear, especially in babies, causing fluid to accumulate behind the eardrum. If this fluid becomes infected, we treat it with antibiotics. But this only patches the problem. It’s important to look for the underlying cause. Repeated ear infections can be a sign of allergies. So if a child is congested for long periods of time, or has three or more ear infections per year, it’s time for an evaluation by an allergist, who is trained to detect symptoms and put together a strategic treatment plan.

The evaluation starts with a history to understand the intensity of the symptoms, then a physical exam, looking in the nose and the ears and a test to detect the fluid in the ear. If the symptoms suggest allergy, then allergy skin testing or blood testing can be done. Contrary to what some believe, young children can be tested for allergies. However, skin test results may be falsely negative at a younger age, and blood testing may be indicated. Once we know what the child is allergic to and how severe the allergy is, we can put together a management plan.

Recurrent fluid buildup and infections can cause hearing loss, so if symptoms continue despite appropriate treatment, the toddler may benefit from surgery. Unfortunately, some doctors wait too long to intervene and stop the cause of the congestion – this results in the overuse of antibiotics as well as potentially unnecessary surgery and hearing loss.