Ear tubes and childhood obesity

Deep down, we knew this was going to be a rough winter. But, DANG!  It has been a REALLY rough winter. It’s our first winter living back in the north, after moving from Texas to Pennsylvania last April, and it’s TheMiniB’s first year in an institutional day care center. It’s a wicked combination that has resulted in a new viral infection sweeping through our household just about every other week. Combine that with a toddler who is finishing up his teething phase, and you’ve got a recipe for the dreaded ear infections!

Otitis media is the clinical term for an ear infection and poor TheMiniB has been plagued with ear infections just about once per month this entire winter. As four ear infections in one year (or three infections in a six-month period) can be enough for a chronic ear infection diagnosis, and we were just diagnosed with our 3rd (or was it our 4th?) infection this year, I am expecting my pediatrician to have a sit-down with me at our 3-week post-infection follow-up. Not surprisingly, the thought of ear tubes has been floating around in my mind. As I know several other parents who are also thinking a lot about ear tubes, a recent publication in the journal, Physiology and Behavior, is well-timed. Titled, ‘Otitis media and associations with overweight status in toddlers,’ this study investigates the hypothesis that the number of ear infections, and especially getting tubes in one’s ears, will be associated with being overweight at age two.  It also considers the reverse hypothesis that being overweight in infancy will predispose individuals to recurrent ear infections.

I had actually never heard of an association between ear infections, tubes, and childhood obesity. However, the authors of this study do provide several supportive references. Although an exact reason for the association is not entirely clear, there is a nerve called the Chorda Tympani Nerve (CT) that sends information about taste from the tongue to the brain. Think of this nerve as a wire, like the wires that send information from the cable company to your TV.  Well, this wire needs to have a path to get from the tongue to the brain, and it just so happens that the path of the CT nerve goes RIGHT THROUGH THE MIDDLE EAR! So, one current theory is that inflammation due to chronic ear infections and/or ear tube surgery results in damage to the CT nerve, which changes the way kids perceive taste, which leads to them having a strong preference for sweet and fatty foods, which ultimately alters their food intake in an unhealthy way.

Data for this publication came from a study that followed a group of children from birth to age two, and was designed to investigate predictors for early onset of ear infections. Scientists kept track of childrens’ ear infections, ear tube placement, and hearing ability. Length and weight were also recorded at two-month and two-year well-child visits, and children were categorized based on their weight-for-length (WFL) percentile. For example, if a child weighed more than 85% of kids their same height, that child was categorized as overweight.  Similarly, if a child weighed more than 95% of kids their same height, that child was categorized as obese.

After controlling for  factors which might influence their conclusions, such as breastfeeding history, day care attendance, birth weight/length, and maternal smoking, the scientists report a statistically significant relationship between ear tube placement and being overweight or obese at age two. However, simply having chronic ear infections without tube placement was not associated with weight status. This means that kids who had tubes placed in their ears before turning two were likely to weigh more than 85% of children their same height.

Interestingly, the reverse hypothesis that being overweight in infancy will predispose individuals to recurrent ear infections was NOT supported by the data collected in this study. Being >85th percentile WFL at two months of age had no bearing on the number or frequency of ear infections, nor did it have any bearing on the frequency of tube placement. This means that if you have a big baby, you are not destined to have lots of ear infections in your future!

I feel it is important to stress that this study was not designed to determine WHY kids with ear tubes tend to be overweight by age two. Current theories that the CT nerve are somehow involved are, at this point, still just theories. Even the authors of this study admit that, while they tried their best to take into consideration all of the variables they could think of that might interfere with their statistical analysis, there could still be variables out there that they did not consider. If you, reader, have any insight into potential confounding variables based on your parental experience, I encourage you to post a comment and we can discuss whether or not the authors took this variable into consideration.

Of course, before you freak out because you just had tubes placed in your kid’s ears, please understand that this does not mean that ALL kids who had tubes in their ears were overweight at their two-year well-child visit. However, what IS clear from this study is that weight gain could be a potential side-effect of ear tube placement. Parents need to be aware of this association and take it into consideration when making decisions for their child’s well-being. At the very least, if a parent believes that ear tubes are in the best interest for their child they might keep in mind this association and actively limit their child’s exposure to sugary/fatty foods while providing an abundance of nutrient-dense foods.

I encourage readers to comment on their opinions of this study, my summary, and their own experiences with ear tubes and/or childhood obesity.

Reference: Nelson, HM et al. (2011) Otitis media and associations with overweight status in toddlers. Physiology & Behavior (102) 511-517.


5 responses to “Ear tubes and childhood obesity

  1. this was pretty relevant for us, since M was also in his first institutional daycare experience this winter and had 2 ear infections! I worry about obesity for him anyway, since my side of the family is pretty predisposed to being overweight. Of course, his father’s people are all tall and elfin-ly thin, so maybe it will balance out, tubes or no tubes? I would be fascinated to read case studies of the kids with tubes who were overweight–were they active kids? did they have family members who were also obese? was it the nerve you mentioned? an interesting study!

  2. You bring up a really good point, Katy. It’s exactly for reasons that you mentioned (family history, current lifestyle, etc) that studies like this are not able to conclude that ear tubes CAUSE a kid to be overweight. There are just too many things that would need to be taken into consideration. But even a few case studies might not give us that information. In this study, only a few hundred kids were followed. Considering all of the considerations that would need to be accounted for, I am not sure that the sample size for any individual confounding factor could be large enough to do meaningful statistics. And then, when you consider potential confounding factors in combination, it sounds like a nightmare of an analysis to me! Likely, all we would be left with is some anecdotal evidence which is not reliable at all. The best we can say is that there is a relationship between the two, and parent accordingly. Thanks for the comment!

  3. The same diet and lifestyle factors leading to childhood obesity also lead to bacterial and viral infections. The standard American high sugar/high glycemic diet coupled with foods that do not provide enough nutrients will lead to a host of chronic illnesses. The picture is not as simple or hopeless as this study suggests.

    • Thanks for joining in, Peggy! I am not sure I totally understand your comment, although I would like to. I wonder what part of the study do you find to be suggesting simplicity or hopelessness? Also, although professional commitments have prevented me from posting in awhile, be assured that I do have other articles in the pipeline to analyze. If you know of any good scientific studies that link diet and bacterial/viral infections, I would love to help spread the word.

  4. Hi Dr. Buchanan! I would say that being powerless to ear infections or invasive treatments in the first place is pretty hopeless and then to think that a child will struggle with obesity because of the ear tubes is also pretty hopeless.

    If not an issue with a mechanical obstruction, ear infections are almost always due to allergy and/or nutritional deficiency. As Linus Pauling wisely said, all illnesses can be traced back to some mineral deficiency. Food allergies are extremely common these days. They cause are often the culprit behind infection, joint pain, mental fog, wheezing… the list goes on, but they are particularly implicated in chronic ear infections. Michael A. Schmidt has done over 16 studies on chronic ear infections and found that allergies, either to foods or airborne, are the cause in many cases. Allergies can cause significant pressure in the inner ear. And of course, deficiencies in certain nutrients can weaken a person’s immune system making them more susceptible to allergies in the first place. Parents should always seek out the cause of chronic illness, which is more often than not nutrition, before treating it with procedures and medications.

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