When young children get ear infections, parents face an unpleasant choice: dose them with antibiotics and pain relievers, or tough it out.
But certain kinds of chewing gum may help reduce the number of ear infections children get in the first place.
That's chewing gum with xylitol, a natural form of sugar sometimes used in gum and candies because it has fewer calories for its sweetness than table sugar, or sucrose.
Giving children xylitol in gum, syrup or lozenges twice a day reduces the risk of ear infections by 25 percent. The finding come from an analysis by the Cochrane Collaboration, an independent group that combs the medical evidence to figure out what works and what doesn't.
But to get any xylitol benefit, parents and their kids are going to have to work at it. "The catch is how you have to take it," says Rochard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y. The children in the studies chewed the gum five times a day for five minutes. "You can't just sort of swallow this like a pill."
Otitis media is the most common infection in young children, prompting almost 16 million office visits in the U.S. and health care costs of $3.8 billion a year. Children with repeated infections are often referred for surgery to insert ear tubes. So you could see how parents eager to avoid antibiotics and ear infections would be intrigued.
Xylitol has been touted for decades to prevent tooth decay, but that's never really caught on in the United States. Unless you've been reading the labels closely, you might have overlooked gums, such as some varieties of Trident, that contain xylitol.
About a decade ago, scientists got interested in it as a potential treatment for ear infections, when a study showed that xylitol reined in the growth of strep bacteria in petri dishes. Streptococcus pneumoniae has been blamed for up to half of all ear infections.
The four studies considered here were all conducted in Finland from 1998 through 2007. They followed 3,103 children in day care. In three of the studies, healthy children were given xylitol in gum, syrup or lozenges twice a day. Those children saw a reduction in the number of ear infections, with the gum giving better results.
The fourth study gave xylitol to children who already had upper-respiratory infections, which often precede ear infections. Those already-sick children didn't see any reduction in the number of ear infections with the xylitol treatments.
"In Finland,they do this all the time," Rosenfeld says. "It's all over the culture." But he doubts if American parents would be able to stick with "kids chomping away, five times a day", through the cold and flu season.
What's more, ingesting too much xylitol can cause diarrhea and other stomach upsets, and xylitol gum and candy can be expensive.
Some caveats: In all four trials, the gum and lozenges were donated by industry, and the study authors have a U.S. patent for using xylitol to treat respiratory infections. But the authors claimed no conflict of interest. The studies were relatively small, and came mostly from the same labs.
Parents who don't want to have to ask their pediatrician if it's worthy trying xylitol to prevent ear infections can make use of this free consult with Dr. Rosenfeld:
"So if a kid in the course of a year gets four ear infections, you start 'em in October and get 'em chomping the xylitol, instead of four infections you get three. That's a 25 percent decrease. Heck, if I'm a parent I'd rather have an ear infection. Most ear infections don't need antibiotics. You give 'em Tylenol for day or two and they get better on their own."
HIs final word: "To me, it doesn't make sense."