Xylitol might help guard against ear infections in healthy young children, according to initial evidence published in a Cochrane review conducted by University of Toronto researchers.
The authors found “fair” evidence that the prophylactic administration of 8.4 g of xylitol (e.g., 2 pieces of chewing gum, 5 times a day after meals for at least 5 minutes) among healthy children attending daycare centres can reduce the occurrence of acute otitis media (AOM) by 25%.
However, Dr. Amir Azarpazhooh, the lead author of the Cochrane review, cautions that “we are not in a strong enough evidence position to make firm clinical practice recommendations on the use of xylitol to prevent ear infections in healthy children.”
The results of their meta-analysis were hindered because the included studies were limited to 3 randomized controlled trials (RCTs) of healthy children aged 12 years or younger, where xylitol supplements of any form (syrup, chewing gum or lozenges) were compared to placebo to prevent AOM. The evidence is further limited since this data came primarily from one research group in Finland and were based on the same group of Finnish preschoolers. Therefore, there is still a need for well-designed, double-blind RCTs to compare the effectiveness of xylitol in the North American population.
Despite these limitations, the authors hope that their results might increase knowledge in the medical and dental professions about the potential benefits of xylitol. “It is encouraging that a common approach in the medical and dental field, based around a single preventive intervention, may have benefits for healthy children,” says Dr. Azarpazhooh.
“Our results were similar to what dentistry already knows about the potential benefits of xylitol,” he continues. “The mechanisms are similar, inhibiting the microorganisms involved in the oral cavity which are responsible for dental caries, or in this case those responsible for AOM.” Xylitol has been shown to reduce the adherence of S. pneumonia and H. influenzae to nasopharyngeal cells in vitro.
When the authors analyzed sub-groups of children within the 3 RCTs, the occurrence of AOM was reduced by 30% in younger children who received xylitol syrup because they couldn’t chew gum regularly. Healthy children at these same daycare centres who were able to chew gum showed a 34% decrease in rates of AOM if they took chewing gum or lozenges. The study also found that xylitol chewing gum was superior to xylitol syrup in preventing AOM among healthy children.