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Pacifiers May Increase the Risk of Otitis Media


  • In young children, does pacifier use increase the incidence of otitis media?

Clinical Bottom Lines

  1. Describe clinical actions to be taken based on the results of your critical appraisal

Summary of Key Evidence

  1. 845 white children in daycare in Finland were followed prospectively for 1-15 months. Monthly symptom sheets were collected and the incidence of otitis media was recorded.1
  2. Information on pacifier use, thumbsucking, breastfeeding, parental smoking and parental education was also collected.
  3. 383 (45.3%) of the children had one or more episodes of otitis media throughout the study.
  4. Of the various factors considered, only pacifier use was associated with an increase in the occurance of otitis media (P=0.007).
  5. In pacifier users, the relative risk of having greater than 3 episodes of otitis media was 1.6 for those younger than two years old (P=0.09), 2.9 for those two to three years old (P=0.01) and 2.5 for those three to four years old.
  6. The authors estimate that pacifier use resulted in approximately one more episode of otitis per child, and overall accounted for 25% of the episodes of otitis media in children under 3 years old.

Additional Comments

  • There was no differentiation based on the extent of pacifier use in each child.
  • Although the diagnosis of otitis media was made by physicians, there was no agreed upon standard definition for diagnosis. In addition, the children were not routinely examined.
  • The majority of the children in the study were three years old or older (57% were 3 years old and 68% were 3 or older). This is beyond the age of major risk for otitis media (and presumably for pacifier use).2
  • Pacifier use could affect the incidence of otitis media by altering the oral flora, acting as a fomite (particularly in the day care environment), or by altering the biomechanics of the child’s mouth.
  • More research is needed on pacifier use and the occurrence of otitis media in young children (under the age of 2 years).


  1.  Niemela M, Uhari M, M Mottonen M. A pacifier increases the risk of recurrent acute otitis media in children in day care centers. Pediatrics 1995; 96:884-888.
  2.  ASPAC Study Team. Clinical Otolaryngology and Allied Sciences 2000; 25: 485-491.


CAT Author: Heather L. Burrows MD, PhD

CAT Appraisers: Alex Kemper, MD

Date appraised: Nov 12, 2001

Last updated December 2, 2001
Department of Pediatrics and Communicable Diseases
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