RHR: How to Prevent and Treat Recurring Ear Infections—without Antibiotics

If you have a kid and your kid gets an ear infection and you take him or her to the doctor, chances are you’re going to walk out of there with a prescription for an antibiotic. For many years, researchers and doctors thought that ear infections were primarily bacterial, which is why they prescribed antibiotics, but we now know that 80% of ear infections are viral in origin, not bacterial, and they’ll actually resolve within four to seven days without any antibiotic treatment at all. This is clear in the research. Unfortunately, the memo hasn’t really gotten out because most doctors are still prescribing antibiotics and most parents are still asking for them.

In this episode, we cover:

8:00  Why ear infections are a big deal
11:56  Four common causes of ear infections
16:51  How to treat chronic and recurring ear infections

Links We Discuss

• Martin Blaser’s new book, Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues

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Full Text Transcript:

Steve Wright: Hey, everyone. Welcome to another episode of the Revolution Health Radio Show. This show is brought to you by ChrisKresser.com. I’m your host, Steve Wright from SCDlifestyle.com, and with me is integrative medical practitioner and New York Times bestseller and gorgeous man right there, Chris Kresser! What’s up, video?

Chris Kresser: Hey, Steve, how are you doing? Pretty exciting, huh? Do you like my high-tech background here?

Steve Wright: Yeah, I think you should get some pictures or something put up.

Chris Kresser: Yeah, in my phone cave? This is what makes the audio so good. We finally figured it out, but it’s not esthetically that pleasing, so you’re just going to have to deal for now with this rather utilitarian-looking background, but it’s all in the name of production quality.

Steve Wright: It’s all for the listeners.

Chris Kresser: Yeah, your background is much nicer, Steve.

Steve Wright: Yeah, I’m blessed with this room right here that mostly just contains a bookshelf and window.

Chris Kresser: That’s perfect, built for video.

Steve Wright: It is.

Chris Kresser: Yeah, we’ve been transitioning to this new format, as I’m sure people have noticed, so we’re going to start doing video for you YouTube watchers out there, and we’re doing somewhat shorter episodes typically that are focused on a single topic, and these are going to be really driven by your questions. We have a new format for submitting those questions. If you go to ChrisKresser.com/PodcastQuestion, there’s a little button you can hit to record a voice question, and then we’re going to shift through those and I’ll pick a question to answer each week and we’ll play back your voice question at the beginning of the episode. I like that because your voices will be included and heard in the show, and I think it’ll be great to do it that way. Most episodes will be maybe 20, 25, or 30 minutes. Of course, if we do an interview, we’ll probably do longer episodes, but we’re going to try this out and see how it works. Let us know what you think of the new format.

Steve Wright: Awesome. Well, I’m excited about the new format, and before we get to this week’s listener SpeakPipe question, I just want to let everybody know that if you didn’t see yet, Chris just invested a whole lot more time and energy into his website and made it even easier now to navigate around. Personally, Chris, I like the new design for sure, and if you go to ChrisKresser.com, you’ll see a big Chris Kresser picture and then right to the right of that is an opt-in box for Chris’ 9 Steps to Perfect Health eBook. It’s a 63-page eBook that has nine different steps that if you haven’t started to think about or implement in your life, I would definitely recommend that you get it and start to think about these things. Don’t probably try all nine at once, but definitely get started one at a time. I think as of now, Chris, there are over 106,000 people that have already opted in for this type of eBook, so it’s a pretty powerful eBook.

Chris Kresser: Yeah, it’s kind of my top tips for optimizing your health, especially for people who are pretty new to it. I cover the basics on diet and nutrition, exercise, sleep, stress management, supplementing wisely, and some of the other lifestyle stuff that we’ve talked about a lot on the show and that I’ve written about on the blog, so it’s a really excellent primer for yourself or for anybody that you know that’s getting started with this stuff.

Steve Wright: Yeah, check it out if you haven’t, and now we’ll play this week’s question. YouTubers, you won’t hear the question. That’s an interesting thing we didn’t think about.

Chris Kresser: Mm-hmm. We’ll have to figure that out.

Steve Wright: So, Chris, what’s question?

Chris Kresser: The question was from a woman from Australia, I think, judging by her accent, and she has a 12-month-old breastfed baby that is getting recurrent ear infections, and she’s wondering what to do about that, and then she specifically asked about grommets as a potential remedy. These are ear tubes, tiny tubes that are put into the eardrum when kids are having chronic ear infections. This is a great question, and it actually leads to several other questions and an interesting discussion, so I thought it would be a good topic to cover on this show.

If you have a kid and your kid gets an ear infection and you take him or her to the doctor, chances are you’re going to walk out of there with a prescription for an antibiotic. For many years, researchers and doctors thought that ear infections were primarily bacterial, which is why they prescribed antibiotics, but we now know that 80% of ear infections are viral in origin, not bacterial, and they’ll actually resolve within four to seven days without any antibiotic treatment at all. This is clear in the research. Unfortunately, the memo hasn’t really gotten out because most doctors are still prescribing antibiotics and most parents are still asking for them. I know of some doctors who are aware of this, but it’s very difficult for them not to prescribe antibiotics because the parents are really distressed. If you’ve ever been around a small child with an ear infection, you know that they’re really painful and difficult. It’s hard as a parent to witness that and not know what to do and feel like you’re powerless, so I certainly don’t blame parents for wanting to alleviate the suffering of their children. The problem is, as I just mentioned, the antibiotic won’t be helpful 80% of the time, and it only works 20% of the time, and that’s a pretty big risk you’re taking, to take an antibiotic when there’s only a 2-in-10 chance that it will work. If antibiotics were harmless, as we originally thought they were, it wouldn’t be a big deal, right? But we know that they’re not harmless, and ironically, taking antibiotics is actually going to increase the risk of getting future ear infections because it disrupts the microbiome, which then makes the child more susceptible to future ear infections, so it becomes almost like a self-fulfilling prophecy – antibiotic for ear infection, more ear infections, more antibiotics, and kids really just get stuck in this loop.

Steve Wright: What about those other two times, though, Chris? Just playing the other side of the coin here, is there a risk to the two times when it would’ve worked?

Chris Kresser: There is a risk, and that’s why this is such a difficult problem because there can be complications from middle ear infections that can go deeper and they can cause all kinds of problems. Up until recently, I think the thinking even for doctors who knew that most of them are viral is, hey, there is a chance of complications if it isn’t treated, so we’ll just prescribe the antibiotic and deal with that in case it is bacterial, and if it’s not, no big deal. But again, the problem is it is a big deal. It’s a much bigger deal than we ever thought it was, and we’re only now beginning to understand the extent to which it’s a big deal.

Why Ear Infections Are a Big Deal

In an ideal world, we’d have, like, a rapid culture where the doctor could just take an immediate culture to figure out right there in the office if it’s viral or bacterial, and even if it’s bacteria, what kind of bacteria it is so that they can prescribe a narrow-spectrum antibiotic that just deals with that particular form of bacteria instead of a broad-spectrum antibiotic that’s going to wipe everything out because typically the antibiotics they prescribe for these things are broad spectrum because they don’t know what bacteria is causing it. That’s ideal but we’re not there yet, and the development of that kind of culture method has been slow. I think it’s possible, but it’s really expensive and it’s going to be a while before we get to that point.

The recommendation that I think makes the most sense to me is to monitor closely, to try some of the things we’re going to talk about that are alternative treatments for ear infections that get more at the viral cause and just monitor closely. If you see your child getting worse and not responding to any of these treatments, then you go back to the doctor and then you could consider an antibiotic to prevent complications. That would lead to far, far fewer antibiotic prescriptions because, as I said, most of these resolve within four to seven days without antibiotics and they don’t get progressively worse.

It’s a huge problem. The average American child has received three courses of antibiotics in their first two years of life, and then they go on to receive another eight courses of antibiotics over the next eight years, 17 courses of antibiotics before the age of 20, and 30 courses of antibiotics before the age of 40.

Steve Wright: That’s average?!

Chris Kresser: This is average, so, of course, some people are much higher than that, and other people are lower. But to have an average of 30 courses of antibiotics before 40 is totally catastrophic.

Steve Wright: Oh, yeah.

Chris Kresser: I think I mentioned Martin Blaser’s new book. Dr. Blaser is a real pioneer in the field of microbiome research. His book is called Missing Microbes, and it details the consequences of overuse of antibiotics. It’s a fantastic book. It scared the hell out of me! There were things I had been aware of for a long time, but to see it all in one place and to see all the statistics and to really consider the possibly permanent changes to the human race…

Steve Wright: Wow.

Chris Kresser: We’re talking about that level of significance because we’re changing our microbiome in such a way and we know now that we pass our microbiomes down to our children, so if we change or eliminate certain species of gut flora that have been living in our guts for millions of years or hundreds of thousands of generations and we wipe them out, we’ve permanently changed essentially what it means to be human because we have 10 times more bacterial cells than we do human cells, so it’s a big deal. It doesn’t mean that antibiotics aren’t necessary. They’re lifesaving. They have to be used in certain cases, and we should continue to use them for those cases, but what we should not do is prescribe them indiscriminately in situations where they’re not likely to be effective. If we just change that alone, it would have a huge difference on the number of prescriptions, and in fact, there are other industrial countries that have much better health care than us in terms of rankings and when you look at infant mortality and all the objective measures, like Sweden, for example, and Denmark, and their prescription of antibiotics is way, way lower than ours, so it’s definitely possible to have really high quality health care without a lot of antibiotic use.

Four Common Causes of Ear Infections

I think actually one of the causes of chronic viral ear infections in kids can be antibiotic use. If a child received antibiotics when they were young, maybe a C-section birth or an initial infection or something like that, that can disrupt the gut flora and predispose them to becoming more susceptible to ear infections as they get older.

Food allergies – this is really interesting. I did some research on this recently, and studies show between 45% and 80% of kids with recurring ear infections have food allergies. In other words, it’s more likely than not that a food allergy is at the root of the chronic ear infections. The most typical would be to gluten, dairy products, soy, peanuts, and some of the non-gluten grains, and we’ll talk a little bit about what to do about that when we get to the section.

Steve Wright: That’s fascinating. I mean, we know from the research also that antibiotic usage predisposes to leaky gut, so that’s obviously the connection – one of the connections, anyway.

Chris Kresser: Yeah.

Steve Wright: Just changing our diets that we give to the kids potentially could stop these cycles. I have several friends whose babies are stuck in these cycles, and I wish they listened to this show.

Chris Kresser: Yeah, and unfortunately in the mainstream there’s still this idea that food doesn’t matter that much for things like this, which is kind of preposterous. The food allergies, I think, contribute via leaky gut, like you said, Steve, and then they activate the immune system and cause this immune dysregulation, which then makes us more susceptible to viral infections, which are the cause of most ear infections.

Another related cause of ear infections would be disrupted gut microbiome. I talked about that in the context of antibiotics, so lack of beneficial bacteria because the breast milk isn’t sufficient in that regard or because the baby is consuming formula, which is not the case for the questioner but is definitely a potential issue. If the baby was born via C-section rather than vaginally, we know now that the initial exposure to bacteria happens in the birth canal, whereas if you have a C-section birth, the initial exposure for the baby to bacteria is actually just to the hospital bacteria, which is obviously not as desirable as the mother’s bacteria in the birth canal. One in 3 births now in the US are C-section births.

Steve Wright: Wow. That’s crazy, but also what I just thought of is I’m picturing this idea that we’re changing the gut flora forever and I’m thinking about the different Third World countries and the hunter-gatherer tribes that are still alive and the fact that I don’t have any kids yet, but all of the babies that I’ve ever seen are, like, wrapped in the most non-microbial environment ever.

Chris Kresser: Yeah.

Steve Wright: Like, if some dirt or something ever got on a newborn, I think everyone would freak out, including myself. I’d be like, Oh, that’s weird!

Chris Kresser: Yeah.

Steve Wright: But in a different time and age, these babies would have been exposed to soil-based organisms right away.

Chris Kresser: Absolutely, right away, and they were certainly born vaginally and they were breastfed 100% of the time, so yeah, a much different environment. So that’s another possibility, and we know that 75% to 80% of the immune cells in the body are in the gut, so if you have changes to your gut microbiome, that’s absolutely going to affect immunity and your ability to fight off these ear infections.

Another problem that can predispose to ear infections is low vitamin D levels, and there was one study I found that showed that of 116 kids, on average, they had low vitamin D levels. The norm in the study was that kids’ vitamin D level was 27 or something, which is below the commonly recognized range of 30. Now, that range is somewhat controversial, and I think that you can make an argument that 27 may not be a problem, especially in kids that young, but we know if that’s the average that a lot of kids had levels of 15, 18, 20, and that’s definitely an issue because vitamin D plays such an important role in regulating immune function.

How to Treat Ear Infections

Those are a few of the causes and things that can increase the susceptibility to chronic and recurring ear infections. Now we’re going to start talking about treatment, and of course, we’re going to be thinking about it in terms of all of these causes. So the goals are we want to eliminate any food triggers that could be contributing to these recurring infections since the food allergies are a factor in many, if not most, cases of recurring ear infections. We want to fix the gut, you know, improve levels of beneficial bacteria, and we want to strengthen the immune system and then also even consider what some botanical or herbal alternatives to antibiotics might be that can be used either internally or topically.

Steve Wright: And you would do this with a newborn that has been having multiple infections and may or may not already have tubes in their ears.

Chris Kresser: That’s right. The first step would be an elimination diet. At 12 months old, baby is probably eating some solid food now, probably not too much, depending on how you’ve done it, but if baby is eating solid food, then you definitely would want to remove gluten, dairy, soy, peanuts, and probably all grains from baby’s diet for a period of time and see how they respond and if this makes a difference. If breastfeeding is still happening a lot, which it sounds like it was, then it probably makes sense for mom to remove those foods from her diet for a period of time. We don’t have a lot of research on how much of these proteins get through the breast milk and into the child’s belly, but I know anecdotally and from working with a lot of moms that changes in mom’s diet absolutely do affect baby when they’re breastfeeding, so I think it definitely makes sense to do that.

The second thing is a nasal spray called Xlear, and this is a xylitol-based nasal spray. Xylitol is a sugar alcohol that breaks down biofilm, and in a lot of cases of any kind of chronic viral infections or chronic infections in general, what happens is biofilm forms and it makes it really hard for the immune system to get rid of whatever’s in that biofilm. Xylitol actually breaks up the biofilm and makes it easier for our immune system to deal with those pathogens. You can use the Xlear nasal spray. If you go to the website, there are some directions on how to do that.

In terms of alternatives to antibiotic eardrops and internal antibiotics, there’s a garlic and mullein oil. It’s sold in a small bottle. I think it’s mixed in a base of olive oil, and there’s garlic and mullein, which are both antimicrobial, and mullein, in particular, has a soothing effect on the ear. So you warm it up slightly, put it is a pan with some hot water so it warms up, and you can put some drops of oil in the ear, and that can be really effective. I actually have used that myself sometimes. I have a condition called surfer’s ear where the bones in my ear have grown closer together because of too much exposure to cold water. It means that sometimes if I’m surfing and I forget my earplugs then my ear will tend to fill up with water, and it doesn’t drain properly and then I can get an infection, and when I do I use the garlic and mullein oil, and it works pretty well.

Steve Wright: Nice. Is there a brand for that that you would trust?

Chris Kresser: I think Herb Pharm makes one, but there should be a few different options, and I don’t think the brand matters quite as much in this case.

Then we have things that are immune stimulants that can help strengthen immunity and that are safe to take even for relatively young kids as long as you’re using the kids’ dosages. There’s elderberry and echinacea. Typically most recommendations are not to give these to kids under 2 years old, but if you have an herbalist or a functional medicine practitioner that’s experienced with treating kids, I think it’s probably fine to do that under supervision. We’ve done that with Sylvie at times if people around her, like her friends, were sick just to help her fight off colds. It’s, I think, safe if you use a low enough dose.

So we have the Xlear, the garlic and mullein oil, and then the echinacea and elderberry. Then we have, of course, vitamin C, which you can use up to 400 mg in a 1 to 3-year-old child. I wouldn’t exceed 400 mg. You have foods like bell peppers, papaya, guava, strawberries, kiwi, broccoli, kale, and other leafy greens that are high in vitamin C, and you can also supplement with vitamin C and that can really strengthen the immune system.

Fermented cod liver, our old friend, which always seems to come up in these discussions, the reason it’s so potent for immunity is it has high levels of vitamin A, retinol, which is the active form of vitamin A, which is very important for the immune system. It has vitamin D, which we just talked about. A lot of kids are low in it. It has EPA and DHA, which are also helpful for the immune system. It has some vitamin K2, which, now we are understanding, plays a role in immune function, and vitamin E and the various quinones, so it’s a really kind of potent immune booster. Cod liver oil was actually Sylvie’s first real food other than breast milk. You can start with that at 9 months if not earlier, and certainly for a 1-year-old you could be using 1 mL or even 1.5 mL or 2 mL during an active infection. A lot of adults that I work with and kids, I hear from their parents, just adding cod liver oil to their routine sometimes dramatically reduces the frequency and severity of colds and flus and other kinds of infections.

Then we have probiotics and prebiotics. Regarding probiotics, for kids under 2, it’s important to use different products than you use with adults. What you want to do is look for strains that are naturally in the gut of infants at that time, and Bifidobacterium infantis is the main one. There’s a product in the US called Ther-Biotic Infant that I like to prescribe for kids under 2 years of age, which is really effective. I’m not sure if there’s an Australian equivalent, but look for Bifidobacterium infantis as the most important strain. Of course, there are fermented foods, too, if your child is old enough to eat them and will eat them. Sauerkraut was actually Sylvie’s favorite food for a number of months early on. She absolutely loved it. I think that was the wisdom of her body speaking. If dairy turns out to not be a problem, there’s dairy kefir. Water kefir is really great, beet kvass. Kombucha I don’t find to be as therapeutic, and it’s a little bit sweeter, so that might not be the greatest idea. And then you can ferment just about any kinds of vegetables and even fruit, so there’s a lot of leeway there to get more fermented foods into the diet.

Prebiotics, though, have a greater impact over the long term in terms of increasing the levels of beneficial bacteria. Probiotics are immune regulators, and that’s important, of course, when you’re trying to address the immune system, but they don’t quantitatively increase levels of beneficial bacteria over time. That’s what prebiotics so. You could use something like I have in my store. It’s Prebiogen, so it’s inulin, larch arabinogalactan, and some other non-starch polysaccharides that selectively stimulate the growth of good bacteria. You could try a little bit of potato starch mixed with something, either yogurt if they tolerate dairy or coconut milk or something like that. Go very slowly and give your child a lot less than the adult dose. For Prebiogen, that would be maybe one-sixteenth of a teaspoon. They say start with a scoop on the jar, and that’s a terrible idea! And the same for resistant starch, any potato starch. Start at a much lower dose and build up slowly over time.

Steve Wright: It seems like if they start playing around with these prebiotics that they should really monitor for increased gas just in case they’ve already developed a SIBO infection or something.

Chris Kresser: Yeah, absolutely, and if your child is 1 year old, they’re not going to be able to tell you, so you’re going to have to watch for pain and listen for changes in their digestion and observe for changes in their stools.

Going back to probiotics, if your child is over 2 years old, I think soil-based organisms make a lot of sense for prevention because some of the bacillus species of bacteria which are in soil-based organisms, their particular claim to fame is their potency as immune regulators and stimulators. Bacillus species and soil-based organisms in general have a particular effect on immune function compared to other probiotic strains, so I think the soil-based organisms are important.

That’s the program. That’s a lot of stuff to focus on. I imagine there will be something there that helps, and I sure hope so because I know it can be really challenging to have these recurring infections.

I want to address the question about grommets, AKA ear tubes, quickly. These are tiny tubes that are inserted into the eardrum under general anesthesia, and they usually stay in place for six months or a year or maybe longer. The reason they do it is the tubes help drain chronic ear fluid that builds up in these recurring ear infections, which is often referred to as glue ear, and that helps an ear infection from occurring again because that glue, the fluid that builds up there, makes the kids more susceptible to recurrent infections. The other idea behind the tubes is if the child is having recurrent infections and they’re not resolving, there’s a potential – even though it’s very rare – for chronic hearing loss to happen, and so the tubes are used to prevent that from happening.

There are some risks, though. As with any surgery, there’s always risk, especially under general anesthesia. A fairly non-significant percentage of people have bad reactions to general anesthesia, and the ears are very delicate structures, so getting in there is potentially problematic. The tubes often leave a little scar that covers about one-sixth of the eardrum, and most doctors and researchers seem to think this isn’t a problem, but the jury is still out. We don’t really know, so there’s a question mark there. And then some studies show that the ear tubes don’t actually work to prevent recurring ear infections, and some kids get just as many ear infections as they did when they didn’t have the tubes. This, I think, gets back to the importance of addressing the underlying problem. If you have a food allergy, if a kid is gluten intolerant, and that’s what’s causing the immune activation, which is then predisposing to ear infections, then using ear tubes is possibly going to help, but if the gluten is not taken out of the diet, then the underlying problem hasn’t been addressed and they’ll just keep getting worse. So I would say ear tubes would be a last resort and that trying all the things that we’ve talked about here would be the starting place.

Steve Wright: Well, I think that’s a lot of information. That’s a lot of different steps to take.

Chris Kresser: Yeah. I hope that was helpful, and I hope everyone is enjoying the new format. Please do let us know in the comments section, and remember to submit your voice questions because that’s what we’re going to be doing now. You can do that at ChrisKresser.com/PodcastQuestion. Please do keep the questions short because you know we’re going to be playing them back during the show and it’s not really possible for me to address individual health concerns, anyway, during the podcast, so keep it short and somewhat general so it can benefit everybody, and we’ll do our best to answer them.

Steve Wright: Awesome. And obviously you can always check us out and leave us a rating on iTunes, the Revolution Health Radio page there, and in between these episodes, Chris always is sharing the studies and the books that he’s consuming on Facebook and Twitter, so you can go to Facebook.com/ChrisKresserLAc and then Twitter.com/ChrisKresser.

Chris Kresser: And Pinterest now. We’re starting to beef up our Pinterest presence.

Steve Wright: I think we’re going to put this on Pinterest right here.

Chris Kresser: Yeah, this beautiful background! Maybe we can Photoshop it, me in a jungle or something or on the beach with my microphone. It is white, right? Someone could cut it out.

Steve Wright: True.

Chris Kresser: All right, everybody, thanks again. Good to see you and talk to you, and we’ll see you next week.