Ear Infections / Otitis

Ear infections, collectively termed otitis, represent a significant health concern in farm animals affecting the external ear canal, middle ear, or inner ear structures depending on the location and progression of infection. Otitis externa involves infection and inflammation of the external ear canal from the pinna to the tympanic membrane, while otitis media affects the middle ear structures behind the eardrum, and otitis interna or labyrinthitis involves the delicate inner ear components responsible for hearing and balance. These conditions can occur independently or progress from one region to another, with deeper infections generally carrying more serious implications for animal welfare and recovery.

Ear infections occur across all major farm animal species, though the specific pathogens, predisposing factors, and clinical presentations vary considerably between species. In cattle, otitis media and interna frequently occur as extensions of respiratory disease when pathogens ascend through the Eustachian tube to reach middle ear structures. Pigs commonly develop ear infections secondary to ear mite infestations or from wounds sustained during fighting and ear biting. Sheep and goats experience otitis from various bacterial and parasitic causes, while poultry may develop ear infections as components of systemic disease processes. The prevalence of otitis varies seasonally and with management practices, increasing during periods of high pathogen pressure or when conditions favor ear irritation and trauma.

The economic and welfare impact of ear infections in farm animals extends beyond direct treatment costs to include production losses, potential permanent disability, and in severe cases, mortality. Animals with painful ear infections typically show reduced feed intake and growth rates, decreased milk production in dairy animals, and impaired reproductive performance. Middle and inner ear infections can cause permanent hearing loss, vestibular dysfunction resulting in head tilt and circling, and facial nerve paralysis affecting the animal's ability to eat and drink normally. In severe cases, infection can spread from the inner ear to the brain, causing fatal meningitis or brain abscesses.

Early detection and appropriate treatment of otitis significantly improve outcomes and reduce the likelihood of complications. External ear infections caught early respond well to topical therapy and correction of underlying causes, often resolving completely without sequelae. Middle and inner ear infections require more aggressive systemic treatment and carry higher risks of permanent damage, making prompt veterinary evaluation essential. Producers should train personnel to recognize early signs of ear discomfort and incorporate ear examination into routine health monitoring protocols to identify infections before they progress to deeper structures.

The primary causes of ear infections in farm animals include bacterial pathogens, parasitic infestations, fungal organisms, and viral agents, often acting in combination with predisposing environmental and management factors. Bacterial otitis most commonly involves organisms such as Mannheimia haemolytica, Pasteurella multocida, Mycoplasma species, Staphylococcus aureus, Streptococcus species, and Pseudomonas aeruginosa, though the specific pathogens vary by species and infection location. In cattle, respiratory pathogens reaching the middle ear through the Eustachian tube represent a major cause of otitis media, while in pigs, secondary bacterial infection of ear mite lesions or bite wounds frequently leads to otitis externa.

Genetic and breed predisposition to ear infections relates primarily to anatomical differences in ear conformation that affect ventilation, moisture accumulation, and accessibility to pathogens. Animals with pendulous ears that fold over the ear canal opening may have reduced airflow and increased humidity within the canal, creating favorable conditions for pathogen proliferation. Certain breeds may also have differences in cerumen production, immune function, or susceptibility to the respiratory diseases that predispose to middle ear infection. While no specific genetic defects directly cause otitis, these conformational and physiological differences influence disease susceptibility.

Environmental and management factors play critical roles in ear infection development across all farm animal species. High humidity, poor ventilation, and dusty conditions irritate ear tissues and favor pathogen survival. Overcrowding increases exposure to respiratory pathogens and provides more opportunities for ear trauma through fighting. Inadequate fly control leads to ear irritation and tissue damage from fly worry and feeding activity. Wet, muddy conditions common during certain seasons introduce moisture and pathogens to the ear canal. Housing systems that expose animals to drafts or extreme temperatures may impair local immune defenses and predispose to infection.

Risk factors for ear infection development include young age when immune systems are immature and passive immunity is waning, recent respiratory illness that may spread to middle ear structures, ear mite infestation creating tissue damage that allows bacterial colonization, traumatic injuries to the ear from fighting or handling, foreign bodies in the ear canal, and immunosuppression from concurrent disease or stress. In cattle, the stress of weaning, transport, or commingling in feedlot settings significantly increases otitis risk. Pigs entering finishing facilities experience high infection pressure during the mixing and hierarchy establishment period.

The pathophysiology of otitis begins when pathogens gain access to ear structures and overcome local defense mechanisms. In otitis externa, bacteria or fungi proliferate in the warm, moist ear canal environment, producing inflammation, discharge, and tissue damage. Otitis media develops when pathogens cross the tympanic membrane from an external infection or ascend through the Eustachian tube from nasopharyngeal infections. Once in the middle ear, infection causes fluid accumulation, pressure buildup, and bone destruction. Extension to the inner ear damages vestibular and cochlear structures, while spread through the temporal bone can reach the meninges and brain. This progressive nature of ear infections underscores the importance of early intervention.

Early warning signs of ear infection in farm animals often include subtle behavioral changes that indicate discomfort before obvious clinical signs develop. Affected animals may shake their heads more frequently than normal, scratch at their ears using hind feet or by rubbing against objects, or hold their heads in unusual positions. Decreased appetite, mild depression, and reluctance to move the head normally can signal developing ear pain. In group-housed animals, infected individuals may separate themselves from herd mates or become less competitive at feed bunks. Observant caretakers noting these early changes can prompt veterinary evaluation before infections progress to more serious stages.

Common symptoms of otitis vary by species and by the specific ear structures affected. Cattle with otitis media and interna frequently present with ear droop, head tilt toward the affected side, and varying degrees of facial paralysis on the same side as the infection. Pigs with otitis externa typically show thick discharge in the ear canal, odor, and visible inflammation of the pinna. Sheep and goats develop similar signs with the addition of wool or hair loss around the affected ear from rubbing. Poultry may show head shaking, scratching at ears with feet, and loss of balance in cases affecting vestibular function. The discharge characteristics provide diagnostic clues, with bacterial infections often producing purulent material while parasitic causes may show dark, crusty debris.

Behavioral changes in animals with ear infections extend beyond ear-directed activities to affect overall demeanor, feeding patterns, and social interactions. The pain associated with otitis can cause significant changes in temperament, with previously docile animals becoming head-shy, irritable, or even aggressive when their ears are approached. Feed intake typically decreases, sometimes dramatically in cases of severe pain or when facial nerve paralysis impairs the ability to prehend food. Animals with vestibular dysfunction from inner ear involvement may appear disoriented, circle toward the affected side, or fall when attempting to walk, particularly on uneven ground.

Physical signs of otitis include visible discharge from the ear canal, swelling and redness of the pinna, heat detectable on palpation, and pain response when the ear is manipulated. In cases of tympanic membrane rupture, discharge may be particularly copious as accumulated material drains from the middle ear. Facial nerve paralysis manifests as drooping of the ear, eyelid, and lip on the affected side, with inability to blink leading to exposure keratitis of the eye. Animals with inner ear involvement often have nystagmus, a rhythmic involuntary movement of the eyes that can be observed during examination. Fever may be present, particularly with acute bacterial infections or systemic involvement.

Symptom progression in untreated otitis follows a predictable pattern as infection spreads from superficial to deeper structures. External ear infections may remain localized for extended periods if treated promptly but can eventually erode through the tympanic membrane to involve middle ear structures. Once otitis media develops, the infection can destroy the small bones of the middle ear, extend to involve the inner ear, or spread through bone to reach the meninges. This progression is often accompanied by worsening neurological signs, increased pain, systemic illness, and declining response to treatment. The timeline varies based on pathogen virulence, host immune status, and environmental conditions.

Emergency symptoms requiring immediate veterinary intervention include severe neurological signs such as inability to stand, persistent circling, or recumbency, which may indicate inner ear involvement or central nervous system extension. High fever, severe depression, and complete anorexia suggest systemic infection requiring urgent treatment. Respiratory distress can develop if brainstem involvement affects breathing centers. Rapid progression of symptoms over hours rather than days indicates aggressive infection warranting immediate attention. Any animal showing signs of meningitis, including neck stiffness, hyperesthesia, or seizures, requires emergency veterinary evaluation and treatment.

Clinical examination of animals suspected of having ear infections begins with observation of behavior and posture from a distance, noting any head tilt, ear droop, or circling tendency before the animal is restrained. Physical examination includes careful inspection of both ears, comparing the potentially affected side to the normal ear. Otoscopic examination of the external ear canal reveals inflammation, discharge, foreign bodies, parasites, or tympanic membrane abnormalities. The character and odor of any discharge provide diagnostic information, with purulent material suggesting bacterial infection and dark, waxy debris indicating parasitic involvement. Palpation of the base of the ear and the area behind the jaw may reveal swelling, heat, or pain consistent with middle ear involvement.

Diagnostic tests for otitis in farm animals help characterize the infection and guide treatment selection. Cytological examination of ear discharge identifies bacterial morphology, inflammatory cells, and parasites such as ear mites. Bacterial culture and sensitivity testing of discharge samples guides antimicrobial selection, particularly important when initial treatment fails or when resistant organisms are suspected. Complete blood counts may reveal elevated white blood cell counts consistent with bacterial infection. In valuable animals, imaging studies including radiographs or computed tomography can evaluate middle ear structures for fluid accumulation, bone destruction, or abscess formation. Cerebrospinal fluid analysis is indicated when meningitis is suspected.

Differential diagnosis for ear-related symptoms in farm animals includes several conditions that may mimic otitis or occur concurrently. Ear mite infestation causes similar ear irritation and discharge but requires specific antiparasitic treatment. Aural hematoma presents with ear swelling but involves blood accumulation rather than infection. Listeriosis causes circling and facial paralysis resembling inner ear disease but results from brainstem infection. Polioencephalomalacia in ruminants produces neurological signs that must be distinguished from vestibular disease. Foreign bodies in the ear canal cause localized irritation without the systemic signs of deep infection. Ear tip necrosis in pigs involves tissue death rather than infection, though secondary bacterial contamination is common.

Herd-level diagnostic considerations become important when multiple animals develop otitis within a short timeframe, suggesting a common predisposing factor requiring investigation. Systematic evaluation should assess housing ventilation, humidity levels, and dust exposure that might predispose to ear disease. Review of respiratory disease incidence in the group helps identify whether otitis media cases are secondary to respiratory infection. Examination of multiple animals for ear mites guides decisions about group treatment. Environmental sampling may identify pathogen reservoirs in bedding, water sources, or shared equipment. Analysis of disease patterns by age, location, or management group can reveal specific risk factors amenable to intervention.

Emergency and immediate treatment of severe otitis focuses on stabilizing the animal, managing pain, and initiating antimicrobial therapy before diagnostic results are available. Animals with signs of systemic illness require supportive care including fluid therapy if dehydrated, anti-inflammatory medications for pain and fever control, and initial broad-spectrum antimicrobial treatment. Nonsteroidal anti-inflammatory drugs such as flunixin meglumine provide both analgesia and antipyretic effects. Corticosteroids may be considered in cases with severe inflammation but must be used cautiously in food-producing animals due to withdrawal time requirements. Animals with vestibular dysfunction should be housed in safe environments where they cannot injure themselves during episodes of falling or circling.

Medical management of otitis externa in farm animals typically involves topical treatment of the ear canal combined with systemic therapy when indicated. Gentle cleaning of the ear canal to remove discharge and debris improves the effectiveness of topical medications. Topical preparations containing antimicrobials, antifungals, and anti-inflammatory agents address local infection and inflammation. Common topical antimicrobials used in livestock include gentamicin, enrofloxacin, and florfenicol, selected based on likely pathogens and culture results when available. All medications used in food-producing animals must have established withdrawal times that are carefully observed and documented. When ear mites contribute to the problem, appropriate parasiticides must be included in the treatment protocol.

Surgical options for otitis in farm animals are generally reserved for cases unresponsive to medical management or those with specific complications requiring intervention. Myringotomy, or incision of the tympanic membrane, may be performed to drain accumulated material from the middle ear in cases of otitis media with intact but bulging eardrum. Lateral ear canal resection improves drainage and ventilation in cases of chronic otitis externa with canal stenosis. In severe cases of otitis media with bone involvement, more extensive surgery may be considered in valuable animals, though this is less common in livestock than in companion animals. Abscesses associated with ear infection may require surgical drainage.

Supportive care for animals with otitis includes environmental modifications, nutritional support, and nursing care as needed. Animals with vestibular dysfunction benefit from housing in small, well-bedded areas where they can brace themselves against walls when standing. Feed and water should be easily accessible, and animals with facial paralysis may need softened feed or assistance eating. Eye lubrication or temporary tarsorrhaphy protects the cornea in animals unable to blink normally. Continued pain management throughout the treatment period improves appetite, reduces stress, and supports recovery. Protection from weather extremes and herd mates reduces additional stress during the healing period.

Herd treatment protocols address ear infections at the population level when common underlying causes affect multiple animals. If ear mites are identified as a predisposing factor, treatment of all in-contact animals with injectable or pour-on avermectins eliminates the parasite reservoir. When respiratory disease is driving otitis media cases, metaphylactic antimicrobial treatment of at-risk groups and vaccination program review may be warranted. Environmental modifications to improve ventilation, reduce humidity, and decrease pathogen exposure protect unexposed animals. Enhanced monitoring of high-risk groups allows early identification and treatment of new cases.

Treatment decisions in livestock otitis cases must consider economic factors alongside medical and welfare considerations. Direct costs include veterinary fees, medications, and labor for treatment administration. Indirect costs encompass production losses during illness and recovery, potential permanent disability, and possible culling of severely affected animals. For otitis externa caught early, treatment costs are typically modest and recovery is excellent. Middle and inner ear infections require more prolonged and expensive treatment with less certain outcomes. Producers working with their veterinarians must weigh these factors when developing treatment plans, always ensuring that animal welfare is protected and that regulatory requirements for medication use and withdrawal times are met.

Recovery timeline for ear infections varies dramatically based on the location and severity of infection, the causative organisms involved, and the promptness and appropriateness of treatment. Otitis externa typically responds within one to two weeks of initiating appropriate therapy, with visible improvement in discharge, inflammation, and comfort often apparent within the first few days. Otitis media requires more prolonged treatment, often three to six weeks of systemic antimicrobial therapy, and may leave residual hearing impairment even with successful resolution of infection. Inner ear infections carry the longest recovery times and highest likelihood of permanent sequelae, with vestibular signs potentially persisting for weeks to months after infection control is achieved.

Post-treatment care and monitoring for animals recovering from otitis includes continued observation for recurrence, completion of prescribed medication courses, and assessment of residual deficits. Follow-up otoscopic examination confirms resolution of external canal disease. Animals that had vestibular involvement should be monitored for gradual improvement in balance and coordination, which often continues for several weeks after antimicrobial treatment ends. Facial nerve function may recover slowly over weeks to months, though some cases result in permanent paralysis requiring ongoing management of associated eye problems. Documentation of treatment provided and animal response supports future management decisions and regulatory compliance.

Prognosis for otitis depends primarily on which ear structures are affected and how promptly appropriate treatment is initiated. External ear infections caught early and treated appropriately carry an excellent prognosis with minimal likelihood of lasting effects. Otitis media has a more guarded prognosis, with good survival rates but significant risk of hearing loss, especially with delayed treatment. Inner ear infections carry the most guarded prognosis, with many animals experiencing permanent vestibular dysfunction or hearing impairment despite successful infection control. Animals that develop meningitis or brain abscess have poor prognosis for survival and recovery. Young animals and those in good body condition generally recover better than older or debilitated individuals.

Return to production considerations for livestock recovering from ear infections include verifying complete resolution of active infection, documenting medication withdrawal times, assessing any permanent functional deficits, and monitoring for recurrence. Animals with residual hearing loss can often function adequately in most production settings, though they may be more easily startled and require modified handling approaches. Those with permanent vestibular dysfunction may adapt and compensate over time but should be evaluated for their ability to navigate pastures, compete at feeders, and maintain body condition. Breeding animals should be recovered completely before returning to reproductive activities, and any animals with chronic changes should be carefully evaluated for their ongoing suitability within the operation.

Vaccination protocols for preventing ear infections in farm animals target the underlying respiratory diseases that commonly lead to otitis media through Eustachian tube spread. In cattle, vaccination against Mannheimia haemolytica, Pasteurella multocida, Histophilus somni, and Mycoplasma bovis reduces the incidence of bovine respiratory disease and its otic complications. Modified-live or killed vaccines should be administered according to manufacturer recommendations, typically before periods of high risk such as weaning or feedlot entry. Intranasal vaccines may provide more rapid local immunity in the upper respiratory tract. While vaccines cannot directly prevent ear infections, reducing respiratory disease burden significantly decreases otitis media incidence.

Biosecurity measures for ear infection prevention focus on controlling the introduction and spread of respiratory pathogens and ear parasites within the operation. Quarantine of new animal introductions allows observation for disease and treatment of any parasites before exposure to the main herd. Separation of animals by age groups reduces pathogen transmission from older, potentially carrier animals to susceptible youngstock. Limiting contact with outside animals, equipment, and personnel reduces introduction of new pathogens. All-in-all-out management of facilities when possible breaks disease cycles and allows thorough cleaning and disinfection between groups.

Nutritional prevention of ear infections involves maintaining optimal immune function through balanced diets meeting all nutrient requirements. Adequate protein and energy intake supports immune cell production and function. Trace minerals including zinc, copper, selenium, and manganese play critical roles in immune responses and should be supplemented appropriately for the species and production stage. Vitamin A supports epithelial integrity in the respiratory and ear canal lining. Vitamin E works with selenium as an antioxidant protecting immune cells. Avoiding nutritional stresses that compromise immunity, such as sudden diet changes or feed restriction, helps maintain disease resistance.

Management practices for ear infection prevention address the environmental and handling factors that predispose to otitis. Adequate ventilation in housing facilities reduces humidity, dust, and airborne pathogen concentrations. Appropriate stocking density minimizes stress, fighting, and disease transmission. Fly control programs reduce ear irritation and tissue damage from feeding flies. Clean, dry bedding decreases pathogen exposure. Prompt treatment of respiratory disease reduces the risk of progression to middle ear involvement. Careful handling during procedures minimizes ear trauma, and ear tag application should use clean equipment and appropriate technique. Routine ear examination identifies early problems before they become severe.

Quarantine and testing protocols for new animals protect existing herds from introduction of ear mites and respiratory pathogens. All incoming animals should be examined for ear mites and treated prophylactically with appropriate parasiticides regardless of findings. Observation for respiratory disease during the quarantine period allows treatment and recovery before introduction to the main group. Testing for specific pathogens such as Mycoplasma may be warranted in closed herds or for valuable breeding stock. Documentation of health status and treatments during quarantine supports herd health management. The quarantine period should be long enough to detect incubating infections, typically at least three weeks.

Daily management and monitoring for ear health should be integrated into routine animal observation activities across all farm animal operations. Personnel feeding, moving, or checking animals should watch for behavioral signs of ear problems including head shaking, scratching, head tilt, or ear droop. Any animals showing these signs warrant closer examination of their ears. In intensive housing systems, systematic observation of all animals at least once daily allows early identification of developing problems. Training all personnel who work with animals to recognize signs of ear disease improves detection rates and supports early intervention. Documentation of any abnormalities observed guides follow-up examination and treatment.

Housing and environmental management significantly influence ear infection risk in livestock populations. Indoor facilities should provide adequate ventilation to maintain low humidity and good air quality without creating drafts. Dust control through proper bedding management, feed handling, and air filtration reduces respiratory irritation. Stocking density appropriate for the species, age, and housing system minimizes stress and disease transmission. Clean, dry bedding materials reduce pathogen loads and provide comfortable resting surfaces. Temperature control within thermoneutral zones for each species supports immune function. Separate housing or treatment areas for sick animals reduces pathogen spread to healthy herd mates.

Herd health programs incorporating ear examination and respiratory disease management provide the framework for ear infection prevention and early detection. Regular veterinary visits should include evaluation of ear health in a representative sample of animals. Integration of ear examination with other routine procedures such as vaccination, pregnancy checking, or body condition scoring ensures consistent surveillance. Respiratory disease monitoring and prompt treatment protocols reduce the respiratory-to-ear infection progression. Parasite control programs addressing ear mites should specify products, timing, and application methods. Record analysis identifying patterns in ear disease occurrence guides targeted prevention efforts.

Record keeping and monitoring systems for ear health enable identification of trends, risk factors, and treatment outcomes within the operation. Individual animal records should document any ear problems identified, diagnostic findings, treatments administered, and responses observed. Aggregate analysis reveals whether certain groups, housing areas, or time periods are associated with increased ear infection incidence. Electronic identification systems facilitate tracking in larger operations. Regular review of ear health records during production meetings or veterinary consultations allows evaluation of prevention program effectiveness and adjustment of strategies as needed. Treatment records ensure compliance with withdrawal time requirements for food-producing animals.

Economic considerations in ear infection management encompass prevention costs, treatment expenses, production losses, and potential culling decisions. Prevention investments include vaccination programs, parasite control products, housing and ventilation improvements, and labor for monitoring. These costs are typically modest compared to the expenses associated with treating established infections, especially those involving middle or inner ear structures requiring prolonged therapy. Production losses during illness and recovery include reduced growth rates, decreased milk production, impaired reproduction, and potential mortality. Animals with permanent disabilities from ear infections may require culling. Cost-benefit analysis supports investment in prevention programs that reduce overall ear disease incidence and severity.

High-risk breeds and species for ear infections vary based on the specific type of otitis being considered. For otitis media secondary to respiratory disease, feedlot cattle of all breeds face elevated risk due to the stress of transport, commingling, and diet change that predisposes to bovine respiratory disease. Dairy calves experience high otitis rates during the preweaning period when respiratory infections are common. Among pig breeds, there are no strong breed predispositions to otitis, though management factors in commercial operations create significant risk. Poultry with reduced feathering around the ear opening may have increased exposure to environmental pathogens. Sheep breeds with pendulous ears may have reduced ear canal ventilation compared to breeds with more erect ears.

Production type considerations influence ear infection risk through their effects on housing, management intensity, and disease exposure. Intensive dairy operations with frequent calf handling and high respiratory disease pressure experience significant otitis media incidence in young stock. Feedlot cattle face the highest respiratory disease risk during the receiving period, with subsequent ear infections developing weeks later. Confinement swine operations may see otitis associated with ear mite outbreaks or ear necrosis from fighting. Extensively managed beef cattle and sheep generally have lower ear infection rates except when specific risk factors such as ear mite introduction occur. Commercial poultry operations may experience ear involvement as part of systemic bacterial infections.

Genetic selection and testing specifically for ear infection resistance is not currently practiced in livestock breeding programs, as these conditions result primarily from environmental exposure and management factors rather than direct genetic susceptibility. However, indirect selection occurs through culling of animals with chronic ear problems and avoiding bloodlines with high susceptibility to the respiratory diseases that predispose to otitis. Selection for immune function and disease resistance in general may provide some protection against ear infections. Breeding programs focusing on ear conformation to improve ventilation and reduce moisture accumulation could theoretically reduce otitis externa risk, though this is not a current selection priority in any major livestock species.

Commonly co-occurring conditions with ear infections in farm animals include the underlying diseases and predisposing factors that contribute to otitis development. Respiratory infections frequently precede otitis media in cattle, with pathogens spreading from the nasopharynx through the Eustachian tube. Ear mite infestation creates tissue damage and inflammation that allows secondary bacterial infection of the ear canal. Immune suppression from concurrent disease, nutritional deficiency, or stress increases susceptibility to opportunistic ear pathogens. Skin conditions affecting the pinna, including sunburn, frostbite, and fly strike, damage tissues and create entry points for infection. Aural hematoma may develop secondary to head shaking caused by ear infection, and the hematoma itself can become secondarily infected.

Conditions with similar symptoms that must be differentiated from otitis include various neurological diseases that can cause head tilt, circling, and facial paralysis without ear involvement. Listeriosis in ruminants produces asymmetric brainstem signs resembling inner ear disease but requires different treatment. Polioencephalomalacia causes neurological signs in ruminants that may be confused with vestibular disease. Brain abscess can present similarly to severe otitis with central nervous system extension. Cervical vertebral problems may cause head tilt without ear disease. Otitis must also be distinguished from aural hematoma, ear mite infestation without secondary infection, and foreign bodies in the ear canal, each requiring specific treatment approaches.

Complications and sequelae of ear infections include extension of infection to deeper structures, permanent functional deficits, and secondary conditions resulting from the primary disease. Otitis externa can progress to otitis media if the tympanic membrane ruptures or erodes. Otitis media can extend to the inner ear, causing permanent hearing loss and vestibular dysfunction. The most serious complication is spread of infection to the meninges and brain, causing meningitis or brain abscess that is often fatal despite treatment. Facial nerve paralysis may be temporary or permanent, with permanent cases requiring ongoing management of associated eye problems. Chronic ear changes predispose to recurrent infections. Animals that survive severe ear infections may have lasting disabilities affecting their productivity and quality of life.