Push-and-Pull Caps Linked with Recurrent Ear Infections in Children

Children who often drink from water bottles with push and pull caps may be more likely to experience recurring ear infections, according to a recent study.

Previous research has shown an association between pacifier use and acute otitis media, leading researchers to believe that the negative pressure generated during sucking may cause intratympanic pressure, leading to the reflux of nasopharyngeal secretions and infections of middle ear fluid. The current study, published in the July 2013 edition of the International Journal of Pediatric Otorhinolaryngology, investigated whether push and pull plastic bottle caps, often used on reusable water bottles and sports drinks, have similar effects.

The researchers conducted interviews over the phone with the parents of 28 children with a history of ear infections and 29 healthy controls with a median age of 5 years. Children were enrolled from the Pediatric Infectious Disease and Otorhinolaryngological Multidisciplinary Outpatient Clinic, and those with concomitant systemic disease, birth defects, or previous ear surgery were excluded from the study. Children were identified as having recurrent acute otitis media if they experienced at least 3 episodes within the previous 6 months or at least 4 episodes within the previous year, and those who drank from bottles with push and pull caps every day were considered to be habitual users.

Among children who experienced ear infections, 50% reported using push and pull caps habitually, compared with just 24.2% of children without ear infections. The researchers conducted a second analysis, adjusting for age as children with recurrent acute otitis media were significantly younger than children in the control group. In this analysis, habitual use of push and pull caps was still significantly associated with recurrent ear infections.

The authors conclude that the results confirm the need for larger studies to identify the age groups at the highest risk for recurrent acute otitis media and to test whether restricted use of push and pull caps reduces ear infections in children.