I started thinking about tubes (without suggestion of Pedatrician) after 6 months are many infections that did not improve with sometimes 3 different antibiotic courses and then injections (strong antib. forgot name?).
When DS got infections--he would sleep in increments of only 30minutes or so when it was really bad. I spent countless drives to pediatrician, urgent care and back for rechecks. Many courses of antibiotics and too much Tylenol and Ibuprofin i was comfortable giving such a young child.
DS also pulled out huge patch of his hair--Dr. suggested as a way to deal with pain?! I asked for a referral to ENT and he aggreed tubes were appropriate.
DS was 15 months old when he had tubes put in. Immediate improvement. Since they fell out around 3 yrs old, he had 2 years clear--no infections. Years later, he has 1 or 2 or 3 per year but only during winter/virus season. Stressful to have surgery on child so young but i'm SOOO glad we did it. Fortunately, my son had no speech/language issues that sometimes come when developing child's hearing is impaired during infections.
DS was never around cigarette smoke. He was breastfed for 6 months and not in daycare. These circumstances supposed should have placed him in low risk for recurrent ear infections.
When I started caring for another child (home daycare) in my home parttime, the infections started and did not relent until tubes. He got his first double ear infection during a bad viral infection (Herpangina) and within 8 weeks of weaning/starting formula full time. That was a rough time for a new parent--i'm glad its over!