Expert Advice -- Chewing Gum to Prevent Ear Infections?

My son is 22-months-old and is troubled by frequent ear infections. What do you know about the prevention of ear infections with xylitol?

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ABOUT THE EXPERT

Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

Ear infections have become frustrating for both parents and doctors. The widespread, inappropriate use of antibiotics has caused the bacteria that produce ear infections to become resistant to some of even the most powerful antibiotics. But while this issue has become a very concerning one, a few things good things have happened. Doctors are beginning to not prescribe antibiotics for colds and viral illnesses, and parents are not expecting antibiotics for illnesses that don't require them. In fact, parents and doctors are now trying to let the body take care of ear infections without antibiotics, a strategy which is successful most of the time. But something else has occurred; researchers are looking for more novel ways to prevent ear infections without the use of antibiotics or surgery. One of these strategies is with the use of xylitol.

Xylitol is a sugar found in many plants and has been used as a substitute sweetener. This sugar is known to inhibit growth of certain bacteria, including the one that is the most common cause of ear infections. Researchers in Finland took this fact and applied it in a scientific manner to try to prevent ear infections in children. Using xylitol as a syrup for younger children and in gum for older ones, these scientists set out to prove that prevention of ear infections could occur, and their results were intriguing.

They were able to reduce ear infections by 30 to 42 percent during the three-month study period. And (not surprising) antibiotic use was also decreased. So, why don't we implement xylitol as a part of our ear infection prevention tactics? Well, unfortunately, there still are a lot of unanswered questions that need to be clarified before this could responsibly be started:

Next page: Will xylitol work in young children?

Will xylitol work in young children when ear infections are the most problematic?

Ear infections are the most prevalent in children between the ages of 6 to 18 months. Xylitol studies have not focused on this age group. Therefore, we don't know if it would even work in these children, let alone what the correct dose of xylitol would be.

Is there a way to easily give xylitol in the United States?

Currently, the answer is no. Many gums in Europe contain a good amount of xylitol. In the US, there are no readily available sources of xylitol that could be used in a manner similar to these studies used it. Even if it were available, the FDA regulates this as a food additive and only allows manufacturers to add the amount needed to provide the intended effect of the food -- which is usually taste. The amount used in these studies is much higher than what is generally used for taste. Therefore, to allow higher amounts of xylitol to be used, the FDA would presumably have to recognize it as being used for health purposes, making it necessary for safety tests to be conducted.

Even if available, is there a convenient way to give xylitol?

These studies gave xylitol five times per day. And each time it was given (either by gum or syrup), it was supposed to be given over a five-minute period. It is hard enough to remember to give a medication three times a day, let alone five times. In a world of daycare and working parents, adherence to a medication given five times per day, every day, is a bit unrealistic.

What about side effects?

In large doses, it can cause diarrhea. But its long-term effects have never been studied. For xylitol to be effective, it would presumably have to given for many months at a time. It has already been recognized that certain bacteria exposed to xylitol for long periods of time can become resistant to its inhibitory effects. It would certainly be a shame to begin this on a wide scale only to have it fail from its overuse in the population.

It is always exciting when the possibility of a simple cure to a complex problem comes along. The causes of ear infections, how to prevent them and how to effectively treat them are certainly complex issues. And no single drug or dietary supplement is going to be the ultimate answer. Research like that done with xylitol is always welcomed and may ultimately lead to a solution. However, more questions need to be answered before xylitol can widely be used on our children. Fortunately, a very large study in this country is currently being organized to help clarify many of these questions. We can all look forward to these results.

I hope this helps.

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