A major new national research trial led and hosted by Alder Hey, investigating the treatment of recurrent ear infections in children, has received £1.7 million in funding from the National Institute for Health and Care Research (NIHR). This marks the first time NIHR has funded a paediatric Ear, Nose and Throat (ENT) research trial of this scale.
The RABBIT trial will explore whether long-term antibiotics are an effective treatment for children under the age of eight who experience recurrent ear infections, a condition that affects thousands of children and families every year.
Alder Hey Children’s NHS Foundation Trust will act as both the sponsor and host site for the study, which will involve 26 research centres across the UK recruiting patients to the trial.
Ear infections are among the most common reasons young children visit GP’s and hospitals. Recurrent infections can cause significant pain, sleep disturbance, hearing difficulties, missed school and nursery attendance, and emotional stress for both children and their families. For some children, repeated infections can also affect speech and language development, social interaction, and overall quality of life.
Clinicians at Alder Hey see more than 100 children each year with recurrent ear infections requiring specialist care. Despite the frequency of the condition, treatment approaches vary considerably across the UK. Current options include repeated short courses of antibiotics, monitoring to allow infections to resolve naturally, or surgery to insert grommets (ventilation tubes) into the eardrum. While grommet surgery can be effective, it can also be costly for the NHS and stressful for families, requiring hospital appointments, anaesthesia, and recovery time.
The RABBIT trial was developed following discussions initiated by the ENT and research teams at Alder Hey, between ENT specialists and infectious disease experts from across the country, who identified a clear lack of evidence around the most effective treatment approach for recurrent ear infections in children. Current national guidelines recognise the lack of evidence surrounding the use of long term antibiotics and recommend the need for trials such as RABBIT. The study aims to provide strong evidence to help standardise treatment guidelines and improve outcomes for children in the UK and potentially worldwide.
If long term antibiotics are shown to be effective, they could become a first line treatment option delivered through primary care, potentially reducing the need for surgery and hospital based treatment. This could significantly reduce costs for healthcare services while making treatment more accessible and convenient for families.
Equally, if the trial demonstrates that long-term antibiotics are ineffective, the findings will still provide valuable evidence to avoid unnecessary treatment.
The trial has been designed in partnership with families, patients, and Alder Hey’s youth forum to ensure the research focuses on outcomes that matter most to children and parents. Families consistently highlighted that reducing the number of infections children experience was their top priority.
Recruitment to the study is expected to begin in October 2026. The research team will recruit participants over a two-year period, followed by one year of monitoring and follow-up to assess the effectiveness of three different treatments- two different types of antibiotics given over a three month period and some children will be monitored to see how the infection resolves on its own.
The study reflects a shared commitment to improving care and outcomes for children and young people affected by recurrent ear infections and is supported by Alder Hey’s 2030 vision, that every child can achieve their full potential.
Mr Sunil Sharma, Chief Investigator for the trial and Clinical Director for ENT Surgery and Audiology and Clinical Lead for ENT Cheshire and Mersey Network and Consultant in Paediatric ENT and Otology at Alder Hey said:
“This is an incredibly important study for children and families dealing with recurrent ear infections. There is currently significant variation in treatment approaches and a lack of strong evidence to guide care. By bringing together expertise from ENT and infectious disease specialists across the country, we hope this trial will provide clear answers about the most effective treatment approach and ultimately improve quality of life for our children. We are proud that Alder Hey is leading and hosting this study, the first time the NIHR have funded a large grant for paediatric ENT and this recognises the strength of the research team working to make a real difference for children and young people.”
*Pictured- some of our ENT surgery team