John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. The ear infection, acute otitis media, brings many children into contact with healthcare practitioners and finding ways to prevent it would have obvious benefits for the children, their families and the healthcare system. In August 2016, a group of researchers from Canada, led by Amir Azarpazhooh from the University of Toronto updated their Cochrane Review and he tells us what they found in this Evidence Pod.

Amir: Here in North America, acute otitis media, or AOM, is the most common bacterial infection among young children; but current approaches to treatment are limited and rely mostly on antibiotics and surgery. This has led to a search for effective preventative measures and one that has shown efficacy, is Xylitol. Xylitol is a substitute for natural sugar that has been shown to reduce the risk of developing dental decay and one of the ways it works is by making it more difficult for Streptococcus pneumonia and Haemophilus influenzae bacteria to stick to nasopharyngeal cells. We wanted to find out just how effective it is for preventing AOM, and the results look promising for some children at least.
We identified five clinical trials that had recruited a total of just over 3400 children. This included one new trial over the previous version of our review but, after considering it carefully, we decided not to add the trial to our final meta-analysis because of the large number of differences between it and the other studies.
The four remaining studies were of reasonable quality, with three randomized trials that included 1826 healthy Finnish children who were attending daycare. However, the small number of studies and the fact that most of included data were from the same research group is worth noting and might limit the applicability of our results.
In summary, we found that Xylitol chewing gum, lozenges and syrup are able to lower the rate of AOM in healthy children who did not have an acute infection in their upper respiratory tract from 30% to around 22%. The results were less clear among children suffering from a respiratory infection or those prone to otitis. There was moderate quality evidence showing no statistically significant difference in AOM for otherwise healthy children with a respiratory infection, and a similar result, but based on low quality evidence among children prone to otitis.
In conclusion, moderate quality evidence from our meta-analysis indicates that healthy children attending daycare had fewer AOM episodes when treated with prophylactic Xylitol, but the evidence among otitis-prone children or those with respiratory infection was not promising or conclusive.

John: If you’d like to find out more about all of the evidence that Amir and his colleagues were able to identify, you can read the full review on the internet. It’s available from Cochrane Library dot com, where you can call it up with a simple search for ‘xylitol and AOM’.