Were it not for ear infections, most of us fleas in primary care would be out of a job. To be more precise, were it not for fear of ear infections, most of us fleas in primary care would be out of a job.

Just yesterday Flea paid a house call to an 8-month old who had been pulling at her ears (she was teething). What if instead, the girl had had a non-infected-looking effusion? Some (many?) fleas would have handed the parents a script for Amoxicillin (some fleas would have handed them a script for Azithromycin, but that is a matter for another day!) Why? This is a perfectly happy, peppy kid who pulls at her ears! What would happen, if we left fluid in her middle ear space for while? Would she go deaf? Would she become language delayed? For the last 40 years or so, most of fleadom, in fact most of the world, believed something dire would come to pass if this child were not antibiosed.

And so it was until Jack Paradise and colleagues at Children's Hospital of Pittsburgh began asking if middle ear effusions were really as big a deal as all that. As early as 1981, Paradise began evaluating the literature on middle ear effusions. He found that the data... well... there wasn't much, and the existing data sucked.

Fifteen years ago, Paradise and colleagues began following a group of kids from Pittsburgh from birth to age 12. Many of these kids got ear infections and had fluid behind their ears. Paradise et al. wanted to know if the ear fluid prevented these kids from acquiring speech and learning correctly.

That study is now ended. Here's the verdict: There appears to be no association between early ear infections and later impairments of speech, language, and cognitive development.

So is that it? Do we pack up our otoscopes and go into real estate?

Not so fast. Science and culture tend to run on different schedules. Even in the presence of the definitive study on the subject, Flea figures his colleagues will continue poking holes in tympanic membranes for a long time to come. What's more (and here's where Flea's colleagues threaten to beat him with blunt objects), ear infections pay the bills. Consciously or uncosciously, fleas will continue to take good care of our hot little bête noire. After all, she's been good to us.