Grant: Operating Grant

Acute Otitis media (AOM) is a common and costly condition in young children.4 By age 3 years, 84 % of children have had at least one episode of AOM and 46 % have had 3 or more episodes. More than one-tenth of insurance claims for children in Quebec are for AOM for a total cost of more than $10 million dollars per year. Parents of children with otitis media report missing 2-3 days of work per episode. Antibiotic treatment has only a modest effect on illness duration and does not necessarily prevent serious complications such as mastoiditis or meningitis which can be fatal. There are currently no widely used interventions that prevent AOM and reduce AOM healthcare expenditures. Xylitol, or birch sugar, is a naturally occurring sugar with antibacterial properties that has been shown in some small RCTs by one research group in Finland to prevent AOM. Xylitol has been used as a natural non-sugar sweetener in chewing gums, confectionary, toothpaste and medicines. It is readily available and can be administered in several forms (chewing gum, syrup and lozenges). In vitro studies have shown that xylitol can reduce the attachment of Streptococcus Pneumoniae and Streptococcus Influenzae to nasopharyngeal cells.8 AOM occurs when the upper air way is colonized with bacteria, viruses or a combination of both that travel from the nasopharynx to the middle ear by the way of Eustachian tube. Streptococcus Pneumoniae and Haemophilus influenzae are the most common causes of bacterial otitis media.In our recent Cochrane systematic review, we showed the safety and efficacy of xyltol in preventing AOM in children up to 12 years of age.10 Our review concluded that there is fair evidence supporting the use of xylitol for the prevention of AOM but noted that the largest included trial showed no benefit and that most of the RCTs were completed by the same research group in Finland. The conclusion of the systematic review was that a large, well designed trial was necessary.