WebMD Medical News
Laura J. Martin, MD
Nov. 17, 2011 -- Middle ear infections are common during early childhood, but the simple strategy of chewing gum with the sweetener xylitol just may be an effective way to help prevent them.
Based on their review of three studies of healthy children from Finland, researchers found that there is "fair evidence" to support the conclusion that kids who chew gum containing the natural sweetener xylitol may have a lower risk of ear infections.
In their analysis of the studies, which included children attending Finnish day care centers, regular consumption of xylitol in the form of gum, lozenges, or syrup was associated with a 25% reduced risk for developing middle ear infections.
The researchers conclude that stronger studies are needed to prove that xylitol prevents middle ear infections, but they add that the findings to date are promising.
"These studies were all from the same research group in Finland," researcher Amir Azarpazhooh, DDS, of the University of Toronto, tells WebMD. "While there is fair evidence to support a benefit, more research is needed to make a firm recommendation about using xylitol to prevent ear infections."
Also known as birch sugar, xylitol is used in many reduced-calorie products including gums, candies, and some baked products.
Because it has been shown to curb the growth of some bacteria, some dentists recommend chewing xylitol-sweetened gum to prevent cavities.
Many middle ear infections occur when bacteria accumulate in the eustachian tubes that connect the nose and ears, so the thinking has been that xylitol may also prevent ear infections by preventing bacteria from growing there.
The review examined three studies that included 1,826 healthy children and a single study involving 1,277 children with respiratory infections who were at high risk for developing ear infections.
Use of xylitol-containing gum, lozenges, or syrup did not appear to reduce middle ear infections in the children who already had respiratory illnesses.
Findings from the studies suggested that xylitol-containing gum was superior to xylitol syrup for preventing middle ear infections in healthy children. There was no difference between xylitol-containing gum and xylitol lozenges in preventing middle ear infections.
By the time they reach age 5, a majority of children have had at least one middle ear infection. About 16 million children in the U.S. visit a doctor each year because of them.
Azarpazhooh says xylitol gum represents a potential preventive strategy for reducing middle ear infections, but head and neck specialist Mark Shikowitz, MD, says the research is far from convincing.
Shikowitz is vice chairman of the department of otolaryngology and communicative disorders at the North Shore-LIJ Health System in New Hyde Park, New York.
"Xylitol may have some [effectiveness] as shown in these pilot studies, but certainly more studies are needed," he tells WebMD.
Since the reviewed studies included only Finnish children, the relevance of the findings to a U.S. population is not clear, Shikowitz says. He points out that antibiotics are not routinely used to treat ear infections in Scandinavian countries the way they are in the U.S.
The research review was conducted for the medical practices review group Cochrane Collaboration. It is published in the November issue of the group's publication Cochrane Library.
SOURCES:Azarpazhooh, A. Cochrane Review, November 2011.Amir Azarpazhooh, DDS, Community Dental Health Services Research Group, University of Toronto.Mark Shikowitz, MD, vice chairman, department of otolaryngology and communicative disorders, North Shore-LIJ Health System, New Hyde Park, N.Y.
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