Chewing gum, lozenges, or syrup with xylitol can reduce the occurrence of middle ear infection among healthy children from 30% to 22%.
Acute otitis media (AOM) is the most common bacterial infection among young children in the United States. AOM creates a thick of sticky fluid behind the eardrum in the middle ear with a rapid onset of ear pain, discharge from ear, or fever. Although serious complications are rare, this common childhood ailment imposes a huge impact on the healthcare system. 62% of children have experienced at least one episode of AOM by the age of one and 83% by the age of three. Antibiotic treatment is costly and raises concerns about the development of antibiotic-resistant strains of bacteria, and surgery is invasive and costly. Given these factors, effective measures for preventing AOM are sought.
An alternative preventive strategy is the use of xylitol or birch sugar, which is naturally found in plums, strawberries, raspberries, and rowan berries. Xylitol has been used for decades as a natural non-sugar sweetener, principally in chewing gums, candy, toothpaste, and medicines. Driven by increasingly health- and weight-conscious consumers, xylitol demand is expected to grow in sugar-free and low-calorie food products, especially in chewing gum. Xylitol has also been noted as being potentially clinically useful in preventing pneumococcal diseases, including AOM. Xylitol can be administered through gum or lozenges to older children, or in syrup for younger children.
A team of Cochrane authors based in Canada worked with Cochrane Acute Respiratory Infections to investigate the effectiveness and safety of using xylitol for treating AOM in children up to 12 years of age, and to update the evidence in the Cochrane Review on this subject which was last published in 2011. The authors identified five clinical trials that involved 3,405 children in daycare. The quality of evidence was moderate for healthy children and children with respiratory infections, but low for otitis-prone children.
Xylitol, administered in chewing gum, lozenges, or syrup, can reduce the occurrence of AOM among healthy children with no acute upper respiratory infection from 30% to 22%. There is no difference in side effects (namely, abdominal discomfort and rash). Based on these results, we would expect that out of 1,000 children up to 12 years of age, 299 would experience an AOM compared with between 194 and 263 children who would experience an AOM if they are provided with xylitol chewing gum. The preventive effect among healthy children with respiratory infection or among otitis-prone children is inconclusive.
“Middle ear infections in children are very common and they are a cause of worry for many parents. A cheap and safe way to prevent these episodes is very welcome,” says Amir Azarpazhooh, from the University of Toronto, Canada and the lead author of the Review. “This study shows that there is evidence for the use of xylitol in preventing middle ear infections. We hope that future studies will widen their sample, determine the ideal dosage of xylitol and, the ideal mode of delivery.”
Read the full Cochrane Review
Visit the Cochrane Acute Respiratory Infections website
- Featured Review: Influenza vaccines for preventing acute otitis media in infants and children
- Press Release: Doctors and patients making decisions together could reduce the number of antibiotics prescribed for acute respiratory infections
- Featured Review: Water precautions for prevention of infection in children with ventilation tubes (grommets)
- Press Release: Effect of natural sweetener Xylitol in preventing tooth decay still unproven