There is fair evidence to show that a daily dose 8.4 g of xylitol (two pieces of chewing gum, five times a day after meals for at least five minutes) can prevent acute middle ear infection (acute otitis media (AOM)) in children without acute upper respiratory infections attending day care centres.
AOM is the most common bacterial infection among young children in the United States. The key step in the disease is colonisation of the upper airway with bacteria which move from the nasopharynx (the part of the pharynx lying directly behind the nasal passages and above the soft palate) to the middle ear by way of a slender passage called the Eustachian tube. By the age of one, approximately 62% of children have experienced at least one episode of AOM; and by the age of three, almost 83% of children have experienced at least one episode. Although serious complications are rare, this common childhood ailment imposes a huge impact on the healthcare system. In the United States, it accounted for almost 16 million office visits in 2000 and costs almost USD 3.8 billion annually in direct and indirect healthcare costs. Antibiotic treatment of AOM is costly and raises concerns regarding the development of antibiotic-resistant strains of bacteria. Surgery is invasive and costly and because of these factors, effective measures for preventing AOM are sought. An alternative treatment is xylitol or birch sugar. Xylitol has been used for decades as a natural non-sugar sweetener principally in chewing gums, confectionery, toothpaste and medicines, and can reduce the risk of tooth decay. This review found four clinical trials in 3103 Finnish day care children, mainly from the same research group. It was found that xylitol (administered in chewing gum, lozenges or syrup) reduced the occurrence of AOM among healthy children with no acute upper respiratory infection by 25%. No significant adverse effects were identified.