Certainly children get colds very often. However, if these runny noses and coughs keep recurring, and the ear pain or hearing difficulties follow each time, parents must not ignore it: frequently repeated upper-respiratory infections can obtain middle-ear infections (otitis media) which can, in turn, affect children's hearing, speech, and even their school performance if the situation is not properly handled. Acute otitis media, along with other pathologies (otitis media with effusion, chronic suppurative otitis media) are very common occurrences during the period of childhood; thus, the majority of children will undergo the situation once at least, and a significant number of them will suffer from it on a recurrent basis. Moreover, these problems still rank among the main reasons parental visits to doctors and children's absences from school are caused.

Why do some kids suffer from ear infections repeatedly? The middle ear can be considered a tiny pocket located behind the eardrum, which is linked to the throat by the Eustachian tube. If that tube is blocked (for example, inflammation caused by a cold, allergy, or even enlarged adenoids), then fluid accumulates, and the development of the bacteria or virus that causes the fluid becomes their breeding ground. Some of the risk factors that have repeatedly been pointed out by various studies are an early age (especially if a child is under two years of age), being in a day-care center (which leads to more infections), exposure to tobacco smoke, insufficient breastfeeding, pacifier use, allergies, and anatomical factors such as craniofacial abnormalities or nasal obstruction. Socioeconomic factors and delayed medical care may also worsen the condition.

What do these risks amount to, really? Ear infections, which happen repeatedly, can cause the retention of fluid in the ear (glue ear), lead to hearing loss that is either temporary or, very rarely, permanent and, additionally, times of chronic ear disease that call for surgery may increase. An​‍​‌‍​‍‌​‍​‌‍​‍‌ absolute necessity, in reality, is that the speech and learning in the classroom can be negatively impacted through temporary hearing loss even during the language acquisition period that is a developmental one; hence, paediatricians and ENT specialists are very serious about it. A number of recent extensive and detailed reviews, in fact, lead to the recognition of such a correlation between middle ear infections in childhood and sustained hearing difficulties or developmental issues, thus they advocate for the follow-up to be very thorough and ​‍​‌‍​‍‌​‍​‌‍​‍‌cautious.

What should the parental reaction be in this case? Initially, don’t overreact; recovery is normal in most children. But still, be attentive: a situation where a child experiences three or more acute otitis media episodes that are well-documented within half a year or four or more within a year is the usual circumstance that indicates the need for a specialist's examination. The general practitioners' recommendations on care mainly concentrate on treating the symptoms in mild cases, administering analgesics, putting the infected area under observation, and using antibiotics judiciously only if a bacterial infection is very likely and the child is very young or is ill. Because of recurrence, after an ENT examination, hearing evaluation, tomography in some cases, and a conversation regarding the removal of the adenoid or insertion of grommets (tympanostomy tubes) to release the middle ear, may be the next steps. The recent Indian consensus articles on the subject reached the same conclusion about these steps and also highlighted the importance of unique care for each patient.

If prevention is good, then most of the time it will work: breastfeeding should be promoted, children should not be exposed to secondhand smoke, hand hygiene should always be closely followed, children who are sick and contagious should not be taken to day care, and allergies or reflux that may irritate the Eustachian tube should be properly treated. Getting vaccinated for flu and pneumococcus is a way to prevent some of the diseases that cause ear infections and, therefore, it is another effective intervention for public health. In case one's hearing is somewhat dull, speech development is behind, or behavior is different (not reacting to quiet sounds, lack of concentration), then hearing should be tested without any delay.

What is most important to remember here is that repeated colds that “settle” in the ear are not only inconvenient; they may also have the potential of causing a decreased hearing ability and slowed down development. First of all, parents should be able to recognize the situation early, primary-care management should be carried out sensibly, and the ENT doctor's visit should be made in time if there is a recurrence of infections; all of these will contribute to children's ability to hear, talk and learn being kept ​‍​‌‍​‍‌​‍​‌‍​‍‌intact.