ATLANTA — Ear infections, a scourge that has left countless tots screaming through the night, have fallen dramatically, and some researchers suggest a decline in smoking by parents might be part of the reason.
Health officials report nearly a 30 percent drop over 15 years in young children's doctor visits for ear infections.
Why the numbers are declining is a bit of a mystery, but Harvard researchers think it's partly because fewer people smoke, meaning less irritation of children's airways. Many doctors credit growing use of a vaccine against bacteria that cause ear infections. And some think increased breast-feeding is protecting more children.
"We're sort of guessing here," said Richard Rosenfeld, a New York-based ear, nose and throat specialist who speaks about the issue for the American Academy of Pediatrics.
To be sure, middle ear infections still plague many U.S. children.
For decades, they were the most common reason parents brought young children to a doctor, according to health officials. The Centers for Disease Control and Prevention hadn't issued a report on them in nearly 20 years.
Cases skyrocketed from 1975 to 1990. The visit rate for children 5 and under more than doubled in that time.
A big reason, Rosenfeld said, was a steady rise in dual-career families. More families put their kids in day care, and day care is a breeding ground for the germs that lead to ear infections.
But the study by Harvard University suggests another contributor: cigarette smoke.
Most ear infections occur after a cold. In children, the ear is more directly connected to the back of the nose, so infections in a child's nose and throat can easily trigger ear inflammation. Such swelling is a fertile setting for the bacteria that cause ear infections.
Cigarette smoke, inhaled through a child's nose, can trigger the same kind of irritation and swelling, said Gordon Hughes of the National Institute on Deafness and Other Communication Disorders.
CDC figures show that 88 percent of U.S. nonsmokers were exposed to secondhand smoke around 1990, but that fell to about 40 percent in 2007 and 2008.
Harvard research indicates the decline coincides with a drop in childhood ear infections.
"When people are smoking less around their kids, when homes are smoke-free, the rate of ear infections can and has decreased," said Hillel Alpert, lead author of a study published recently by the journal Tobacco Control.
At the request of the Associated Press, the CDC checked its recent trend data on ear infections, based on annual surveys of a representative sample of doctors.
For children ages 6 and under, the number of medical visits in which the main diagnosis was ear infection dropped by nearly 30 percent from 1993 to 2008 — from an estimated 17.5 million visits to about 12.5 million.
The trend downward for very young children seems to have leveled off in the past few years.
A CDC analysis of data from 2004 through 2008 found the year-to-year differences were not meaningful, said Susan Schappert of the CDC's National Center for Health Statistics.
Some doctors have noticed fewer ear infections compared to what they saw years ago. "We don't see them that much anymore," said Michael Baron, a family practice doctor in Stone Mountain, a suburb of Atlanta.
Another factor in that decline may be growing use of a vaccine that protects against strep bacteria that can cause ear infections. The vaccine, first licensed in 2000, would not account for the drop in cases in the 1990s, but probably has contributed to the decline since, several experts said.
Also, some studies have credited antibody-rich breast milk with lowering infants' risk for respiratory and middle ear infections. About 77 percent of new mothers breast-feed, at least briefly, up from fewer than two-thirds in the early 1990s.