BODY WATCH : The Never-Ending Earache Debate : Ear infections are very common--90% of children will have had at least one by the time they turn 6. But doctors have yet to agree on the best treatment.

“Mommy, my ear hurts.”

The refrain is all too familiar to many parents, for few children totally escape this frustrating and persistent childhood ailment.

On any given day, up to 30% of American children will be suffering from an ear infection, according to one study. And 90% of youngsters will have had at least one by the time they turn 6.

Moreover, half of those who have ear infections before the age of 1 will have six or more within two years, says Dr. Kenneth Grundfast, chairman of the department of otolaryngology at Children’s National Medical Center in Washington.

Despite the fact that ear infections are so common, there is little consensus--and considerable debate--among doctors about how to treat them.

This year, a federal advisory panel issued its verdict on one piece of the problem: Its members recommended that children with persistent fluid buildup in the ears--a common condition that often leads to chronic ear infections--should first be treated with “watchful waiting.”

The committee, convened by the Agency for Health Care Policy and Research, said that fluid buildup should not be treated until it has lasted at least three months. The condition, known as otitis media with effusion, often disappears by itself within that time period, they said.

Normally, fluid produced in the middle ear drains through the Eustachian tube, a tiny channel that connects the middle ear to the back of the throat. In children, fluid accumulation is common because their Eustachian tubes tend to be shorter, narrower and more horizontal than in adults.

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An ear infection occurs when bacteria begin to grow and more fluid is produced as part of the body’s response to the infection. Fluid presses against the eardrum causing pain and a red, bulging eardrum.

Sometimes ear infections will clear up without treatment. But most doctors choose to treat infections aggressively--maybe too aggressively.

Physicians in the United States “probably over-treat” for suspected ear infections but do so only “because the complications can be life-threatening and one wants to hedge on the side of caution,” says Dr. Maureen Strohm, associate professor of clinical family medicine at the USC School of Medicine. These rare complications include a perforated eardrum, mastoiditis (an infection of the mastoid bone behind the ear) or meningitis.

Doctors are particularly quick to address persistent fluid in the middle ear because fluid that lingers can impair hearing. This can be especially critical for a child younger than 2 who is learning to speak.

In treating ear infections and persistent fluid, the choices usually follow two basic routes: first, therapy with antibiotics or other drugs, and--as a last resort--surgery, Strohm says.

Usually, 10 to 14 days of antibiotics will eliminate infections. Even when the drugs work, however, they don’t always solve the problem. Many children quickly develop new infections because antibiotics don’t always eliminate the fluid, and bacteria simply begin to flourish again. Many doctors recommend a course of preventive, low-dose antibiotics to keep ear infections from occurring and to rid the middle ear of fluid.

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Surgical incision of tubes is the most controversial of all treatments for ear infections and persistent fluid--yet it is now believed to have replaced tonsillectomy as the surgical procedure most frequently performed on children.

There is considerable disagreement about when the procedure is necessary. Often, it depends on the length of time a child has had fluid, the number of ear infections in any given period, the extent of hearing loss and the child’s age. For example, a child under the age of 2 who has had recurrent ear infections in any given period and has persistent fluid that is not eliminated by antibiotics would be a good candidate for tubes.

The simple, outpatient surgery involves making a tiny incision in each eardrum, draining out the fluid--known as a myringotomy--and inserting a tiny ventilation tube in each hole. This enables air to reach the middle ear and prevents further accumulation of fluid.

Children with tubes rarely suffer infections. Even more important, the tubes dramatically improve hearing.

Like any surgery, there are risks, such as reaction to the anesthesia. Moreover, the tubes usually fall out in six to 12 months and sometimes the hole does not heal properly, requiring more surgery.

“The tubes are proven to be effective,” Grundfast says. “They reduce the frequency of infections and they restore normal hearing. But like any surgery, they are to be used only when medical therapy fails.”

Despite the controversy, there is almost always good news ahead. Most children outgrow ear infections by age 6.

“Although ear infections are a real problem and very difficult for parents while they are occurring, it should be reassuring to know that children eventually do grow out of them,” says Dr. Dean Blumberg, assistant professor of pediatrics at UCLA. “Parents should keep this in mind: Eventually, it will get better.”