Chewing Gum Cuts Ear Infection Risk in Kids




Ear infections are extremely common, especially in runny-nosed kids. The latest research indicates that when young children get 1) ___, they end up with an ear infection 61% of the time. Chewing gum containing xylitol may actually prevent ear infections in kids. Xylitol is a sugar alcohol derived from the sugar xylose. Xylitol comes from birch bark. An alternative sweetener, Xylitol helps prevent cavities and sweetens foods made for diabetics. It contains 40% fewer calories than sugar and still provides a sweet flavor.


Xylitol originates from the fibers in fruits and vegetables, including mushrooms, raspberries, strawberries, yellow plums, lettuce and cauliflower. In fruits and vegetables, xylitol constitutes less than 1%, according to a study led by researcher R. Sreenivas Rao. The act of chewing and 2) ___ assists with the disposal of earwax and clearing the middle ear, while the presence of xylitol prevents the growth of bacteria in the eustachian tubes (auditory or pharyngotympanic tubes) which connect the 3) ___ and ear.


When bacteria enter the body, they adhere to the tissues using a variety of sugar complexes. The open nature of xylitol and its ability to form many different sugar-like structures appears to interfere with the ability of many bacteria to adhere. In a double-blind, randomized, controlled trial, saline solutions of xylitol significantly reduced the number of nasal coagulase-negative Staphylococcus bacteria. The study attributed the benefits to the increased effectiveness of endogenous (naturally present in the body) antimicrobial factors. In a small clinical trial nasally administered xylitol reduced ear complaints in children previously having chronic complaints, on the order of almost one a month, by more than 92%. Beneficial effects on asthma with nasal administration, have also been reported.


In a meta-analysis of three Finnish studies, children who chewed 4) ___ — or took other products laden with xylitol, including lozenges or syrup — had about a 25% lower risk of developing acute otitis media compared with control interventions, Amir Azarpazhooh, DMD, of the University of Toronto, and colleagues reported in Cochrane Reviews. “Based on the studies we reviewed, xylitol seems to be a promising alternative to conventional therapies to prevent acute otitis media among healthy 5) ___,” they wrote.


Acute otitis media is the most common infection for which kids are treated with 6) ___, which has spurred concerns over antibiotic resistance. So researchers have searched for alternative means of prevention or treatment, not all of which have been successful. Xylitol, or birch sugar, has been one such alternative. It’s a five-carbon polyol sugar alcohol found in a number of fruits, which has been shown to inhibit the growth and acid production of certain bacteria, particularly S. mutans. It is for this feature that some dentists recommend it for preventing 7) ___, the researchers said.


Since a key step in the pathogenesis of otitis media is the colonization of the upper airway with 8) ___ that move from the nasopharynx to the middle ear via the eustachian tubes, the researchers hypothesized that it may be effective for preventing middle ear infections. So they conducted a review and meta-analysis of four studies: three randomized controlled trials in 1,826 Finnish children, and another among 1,277 Finnish children in day care who had a respiratory infection. In a meta-analysis of the three trials, the researchers saw a reduced risk of acute otitis media in children who were given 8 to 10 g/day of xylitol in any form — either as gum, a lozenge, or syrup — compared with control interventions (RR 0.75). In the fourth trial, however, xylitol had no effect on reducing the occurrence of acute otitis media in kids with upper respiratory infection.


Gum appeared to work best; in healthy children, chewing xylitol was superior to syrup at preventing otitis media (RR 0.59), though it had no advantages if given during respiratory infection. There were no differences between xylitol lozenges and syrups in preventing ear infections in healthy kids or in those who had respiratory infections, and there was no difference between gum and lozenges for preventing 9) ___ infections in healthy kids or in those with a respiratory infection. The authors noted that the study was limited because the data arise from a small number of studies, mainly from the same research group.


A number of factors prevent xylitol chewing gum from being used more widely to prevent ear infection. First, school rules against chewing gum may hamper its preventive use in a place where it may be needed most. Also, previous surveys have shown that only about half of clinicians know about the medical uses of xylitol.

Still, Azarpazhooh and colleagues concluded that a daily dose of about 8 g of xylitol — potentially as two pieces of chewing gum five times a day after meals for at least five minutes — can prevent acute otitis media in kids without acute upper respiratory 10) ___.


ANSWERS: 1) colds; 2) swallowing; 3) nose; 4) gum; 5) children; 6) antibiotics; 7) cavities; 8) bacteria; 9) ear; 10) infection


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