there was a Scandanavian study 20 yrs back that insisted we didn't need to treat them with antibiotics, but given the complications, we usually did anyway.
Why? Because in the Scandanavian study, they followed up cases and only treated them if the infection persisted.
In my practice, with lower class rural folks or on "the Res" that was not something that was practical. So better to overtreat than risk a complication.
What was the first game changer was the H Flu vaccine, a common cause of ear infections and meningitis.
Then came the pneumonia vaccine.
Soon we not only saw fewer ear infections but fewer cases of draining ears and meningitis. How fewer cases? Well, so few that I lost my skill in doing spinal taps in squirming toddlers and had to ask the pediatrician to do it. (if you do fewer than 6 procedures a year, you should drop the procedure, unless you can practice it on a dummy, as in CPR training).
It also has to do with other practices: Breast feeding not only increases the kid's immune system, but it keeps kids away from the custom of putting them to bed with a bottle, leading to both ear infections and bottle teeth in toddlers.
The reason goes back to the parents and the good decisions they’re making, to immunize their children, to breast-feed their children, to not smoke around their children,” Dr. Byington said. “It’s parents making these good decisions for their kids, and it’s paying off.”
and yes, even poor parents will take the cigarettes outside.
Alas, in poor rural area, another risk factor is the wood stove...not the stove per se, but the mold on the wood sitting by the stove, and the ashes in the atmosphere when you cleaned it out, and of course the fumes when you went outside.
But I don't know of any scientific studies on this off the top of my head...it's just something docs in rural areas "know".