Why Does My Baby Keep Getting Ear Infections? Look at the Swallow.

Most parents think of an ear infection as exactly that, a problem with the ear.

Sometimes, though, it is worth looking a few inches away.

At health:latch, one of the things we pay attention to is how a baby uses their tongue and palate during feeding and swallowing. That is because your baby's mouth, throat, and middle ears are connected by an important piece of anatomy called the Eustachian tube.

Your ears are designed to drain

Behind each eardrum is a small air-filled space called the middle ear. Connecting that space to the back of the nose and throat is the Eustachian tube.

That tube has several important jobs. It helps equalize pressure in the middle ear, protects it from secretions coming from the nose and throat, and helps clear fluid from the middle-ear system.

Most of the time, the Eustachian tube stays closed.

Then your baby swallows.

During swallowing, muscles around the soft palate activate and help open the Eustachian tube. One of the most important is a tiny muscle with a big name: the tensor veli palatini.

Think about what happens when your ears "pop" while you're on an airplane and you swallow. You are experiencing part of this system at work.

Researchers have identified the tensor veli palatini as a key muscle responsible for actively opening the Eustachian tube. When the tube does not open and function properly, pressure and fluid can accumulate behind the eardrum.

So what does swallowing have to do with ear infections?

Potentially, quite a bit.

A mature swallow involves coordinated movement of the tongue, palate, jaw, throat, and surrounding muscles. This coordinated muscular activity occurs in the same neighborhood as the muscles responsible for opening the Eustachian tube.

Researchers studying children with recurrent ear problems have found that poor active Eustachian tube function appears to be an important factor in susceptibility to recurrent acute otitis media and middle-ear effusion.

There is another interesting piece of research.

One study compared children with chronic otitis media with effusion with children without the condition and specifically evaluated sucking habits and swallowing. The researchers found an association between atypical swallowing patterns and chronic middle-ear effusion. This does not prove that an abnormal swallow causes ear infections, but it raises an important question about the relationship between oral function and the ears.

What about a low tongue position?

This is where we need to distinguish what we know from what we are still learning.

We know that swallowing helps activate the muscular mechanism that opens the Eustachian tube.

We know that poor Eustachian tube function contributes to fluid accumulation and middle-ear disease.

We also have evidence associating atypical swallowing with otitis media with effusion.

What we do not yet have is strong evidence proving that a baby's low tongue position directly causes ear infections.

Still, when we see a baby struggling to breastfeed, unable to elevate and coordinate the tongue well, swallowing inefficiently, and later experiencing recurrent middle-ear problems, we think that relationship deserves attention.

The ear may be where the symptom appears. The ear may not be the only place worth looking.

Breastfeeding gives us another clue

This connection becomes even more interesting when we look at breastfeeding research.

A systematic review and meta-analysis of 24 studies found that breastfeeding was associated with fewer episodes of acute otitis media during the first two years of life. Exclusive breastfeeding for six months was associated with approximately a 43% reduction in the odds of experiencing acute otitis media during those first two years.

The American Academy of Pediatrics has also recognized the association between exclusive breastfeeding and reduced rates of acute and recurrent otitis media.

Breast milk itself provides important immunologic protection, so we cannot attribute this difference simply to swallowing mechanics. Feeding method, immune protection, microbial exposure, anatomy, age, daycare exposure, respiratory infections, smoke exposure, and other factors can all influence ear infections.

Still, breastfeeding is also an extraordinary oral-motor activity.

A baby has to coordinate the tongue, jaw, palate, swallowing muscles, breathing, and nervous system hundreds of times during a feeding.

That makes feeding function another piece of the story worth considering.

Look beyond the ear

Recurrent ear infections deserve appropriate evaluation by your child's pediatrician or ENT. Sometimes antibiotics, hearing evaluation, monitoring, or tympanostomy tubes are exactly what a child needs.

We also believe it is reasonable to ask another question:

How is this child functioning?

How do they use their tongue?

How do they swallow?

How do they breathe?

Did they struggle with breastfeeding or bottle feeding?

Do they mouth breathe?

Does their tongue rest low in the mouth?

Are there other signs of oral-motor dysfunction?

These questions do not replace traditional medical care. They help us look at the whole baby.

At health, that is where we believe some of the most interesting answers begin.

Sometimes an ear problem deserves a closer look at the swallow.

If you are interested in the information above, check out this research article called “Deleterious sucking habits and atypical swallowing in children with otitis media with effusion”

Radically kind, Dr. Thomas