About one third of all children experience recurrent episodes of acute otitis media. Although there are many preventive strategies, none seem to be indisputably effective. Adenoidectomy may benefit the middle ear by removing a source of infection from the nasopharynx (Ann Otol Rhinol Laryngol 1991;100: 226-31) and has been shown to be helpful in children over 4 years of age with chronic otitis media with effusion.  In contrast, there is much less evidence of the efficacy of adenoidectomy in preventing recurrent episodes of acute otitis media. Adenoidectomy, as the first surgical intervention, did not have a significant effect on recurrent episodes in children over age 3 (JAMA 1999;282: 945-53), but among the children previously treated with tympanostomy tubes it reduced further attacks (JAMA 1990;263: 2066-73). 

No research has ever been done on the benefit of live-culture yogurt orally or intranasally for otitis media.  However, one study did show a 19% decrease in pathogenic nasal bacteria with oral live-culture yogurt.

Adenoidectomy, Antibiotic Prophylaxis Both Fail to Help Under Age 2: In a randomized Finnish study of 180 young children with otitis media, one third had adenoid surgery, one-third were treated with sulphisoxazole antibiotic daily for six months, and one-third received placebo medication. No significant differences were observed between the groups in the numbers of episodes of acute otitis media, visits to a doctor, antibiotic prescriptions, and days with symptoms of respiratory infection over the next 6 or 24 months. Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial. Petri Koivunen et al. BMJ  2/28/2004;328:487

E. Coli Probiotic for Newborns Reduced Childhood Infections: In a Czech study of 150 full-term and 77 pre-term infants, intentional colonization of the intestine with non-pathogenic E. coli after birth (offering the advantage of the first colonizer) was found to decrease the incidence of allergies and repeated infections at age 10, but no difference remained at age 20 for infections although the lower rate of allergies was still significant. Int Arch Allergy Immunol. 2003 Jul;131(3):209-11

Gastric Reflux: Most Otitis Media with Effusion Due to Gastric Reflux: 65 children with myringotomies had fluid tested for pepsin. Antireflux therapy might help otitis media. Tasker, University of Newcastle, Laryngoscope 112:1930-4;’02

Non-Antibiotic Treatment with Back-Up Treatment Best: 194 children between 1 and 12 years of age with uncomplicated AOM. Exclusion criteria if > 101.5° F, history of ear infection in the previous three months, signs of another bacterial infection, and toxic appearance. Families received acetaminophen, ibuprofen, or topical otic anesthetic drops for pain control, as well as an antibiotic prescription with instructions not to fill it unless symptoms either increased or did not resolve after 48 hours. 194 subjects, 175 (90%) completed the follow-up interview, and 55 (31%) of these had filled their antibiotic prescription. Compared with their previous experience, parents were overwhelmingly willing to treat AOM with pain medication alone (χ² = 111). The pain medication was reported to be effective by 78% of parents (95% confidence interval [CI], 71% - 84%), and 63% of parents reported that they would be willing to treat future AOM episodes with pain medication alone and without antibiotics (95% CI, 55% - 70%). Siegel, 9/03 Pediatrics; Acute Otitis Media accounts for over 50% antibiotics given to kids.

Povidone-Iodine Ear Drops Work Very Well: Cipro ear drops or pills are considered the gold standard in treating ear infections.  However, bacterial resistance is starting to appear. In a study of chronic suppurative ear infections, povidone-iodine drops worked just as well (88% vs. 90%).  While no bacteria was resistant to povidone-iodine, 17% were resistant to cipro. Povidone-Iodine is also much less expensive. India. C. Jaya. Arch Otolaryngol Head Neck Surg. Oct./2003;129:1098-1100

Xylitol Helped Prevent: Xylitol gum or syrup helped decrease by 30% in DB study. Pediatrics ’98; 102:879-84