Pediatric Ear Infections and GERD

Pediatric Ear Infections and GERD

Published on Monday, August 08, 2022 by Haley McGaha

Does your child struggle with ear infections or have you been told your child has fluid on the ears?

Ear infections are super common in children and per the National Institute of Health- 5 out of 6 children will experience an ear infection prior to their first birthday.

Ear infections (otitis media) are defined as inflammation in the ear and can happen due to trapped bacteria due to a cold or other respiratory infections. Otitis media with effusion (OME) is a term for trapped fluid in the middle ear and does not mean the ear is infected.

Did you know studies have been showing that GERD may increase the risk for ear infections and fluid retention in the ears in children? So, what does the research say about its connection?

Well, in order to know for sure, more studies are needed.

But, let's take a look and see what Z-H Wu et al. (2020) determined.

How could these possibly be related?

Anatomy. The Eustachian tube is shorter in children compared to adults and the tube is positioned horizontally. Because of the positioning of the tube, back-flowed content of the stomach can reach the middle ear. Some studies have reinforced this due to the detection of gastric pepsin/pepsinogen, acid, bile acid and H. pylori in the middle ear.

What did they look at?

The article written by Z-H Wu et al. (2020) looked at 13 articles and the overall sample size of their meta-analysis was 1,961. In order to be included in the meta-analysis, research on pepsin/pepsinogen concentrations, H. pylori testing and 24-hour pH monitoring were reported in OME patients.

What were the results?

They concluded that pepsin concentration in the middle ear was a key factor in retention of fluid in the middle ear space. They also saw that anti-reflux therapy in GERD patients significantly alleviated the signs and symptoms of OME. Overall, they gathered that GERD may play a major role in OME pathogenesis.

What is recommended?

Well, this article recommends children be evaluated for GERD prior to undergoing surgery for recurrent ear infections or OME. During the evaluation, this article recommends anti-reflux treatment (like medication and lifestyle changes which can be found here for infants or here for children) to see if the child’s ear infection/fluid recurrence stops. If not, surgery may be warranted. By trialing anti-reflux treatment, this will hopefully prevent unnecessary surgical procedures as well as overuse of antibiotics.

Things to consider.

There are still conflicting results and more studies are needed, especially on a larger population. Hopefully, more studies will start looking at the possible correlation between acid reflux, fluid in the middle ear, and ear infections in children in the future.

As always, talk to your child’s pediatrician if you have concerns of recurrent ear infections/fluid on the ear to help find a route cause.

Wu, Z.-H., Tang, Y., Niu, X., Sun, H.-Y., & Chen, X. (2020). The relationship between otitis media with effusion and gastroesophageal reflux disease: A meta-analysis. Otology & Neurotology, 42(3).

U.S. Department of Health and Human Services. (n.d.). Ear infections in children. National Institute of Deafness and Other Communication Disorders. Retrieved July 30, 2022, from

Ear infections in babies and toddlers. Johns Hopkins Medicine. (2022, April 13). Retrieved July 30, 2022, from

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