This chapter discusses aspects of treating infants and children with Eustachian tube Irritation [ETI].

Each child with ETI is different. Although the basis of the problem is the same, each child has differences in the severity of each aspect. Some of these differences are subtle, and some are not as subtle. The personalities of the children are also different so the way they respond to the problems differs. Children also respond differently to medications and other management strategies. Parents have different backgrounds of knowledge, expectations and tolerance of particular aspects of the child’s problems. These must all be considered when evaluating and treating the child.

From the history and examination, the decision is made about managing the problems for individual children.

The aspects that are discussed are reflux, atopy, middle ear problems, and the sequelae. Some of these issues are also discussed in other chapters….


Treating infants with ETI requires looking at the various aspects of the problem [i.e., reflux, atopy] and the types of ME problems that can occur.

It is important to look at all aspects for each child and decide which are most important at that time for the individual child. Treating only one aspect may not produce adequate improvement.

There is disagreement about the treatment of middle ear problems.

I believe in being very active in management and look at many aspects, including the risk factors for individual children—particularly time spent in day care, contact with people who smoke, swimming in indoor heated public pools, etc.

Not every one agrees with my management strategies and some believe that time will cure most of the ME problems.

Although most children will outgrow their reflux, food intolerances and ME problems, I am concerned that the longer middle ear effusions persist or the more frequently there are recurrences of ear infection, the greater the risk of the child developing significant sequelae, with implications for school learning, self-esteem and eventual social and economic outcomes….