Xylitol nasal spray for prevention of recurrent acute otitis media in children: A prospective two-center cohort study

Abstract

ObjectivesThe purpose of this study was to assess the effectiveness and safety of xylitol nasal spray as a prophylactic treatment for children with recurrent acute otitis media (AOM). MethodsThis is a prospective pilot study of children aged 1–4 years, diagnosed with recurrent AOM (at least three episodes in the three months before recruitment) between December 1, 2019 and January 31, 2023. Children were treated with nasal xylitol spray 2–3 times daily for 3 months. The number of AOM episodes and treatments administered were compared within 3-month intervals: before recruitment, during xylitol use, and during the three subsequent months. ResultsOf 68 children enrolled, 66 (97%) completed the follow-up, until July 2023. Thirty-eight (58%) were males. Sixty-three children (95%) were 12-24-months old. The mean number of AOM episodes during xylitol use, 1.06 (95% confidence interval [CI]: 0.73–1.39), was lower than in the 3-month previous interval, 4.12 (95% CI: 3.89–4.40), p < 0.001; and similar to that in the subsequent 3-month interval, 0.79 (95% CI: 0.49–1.08), p = 0.082. A similar pattern was observed in an analysis of the number of AOM episodes per patient month. The data were similar during spring and summer months as during autumn and winter months. Across the consecutive three-month intervals, decreases were observed in the mean number of AOM episodes treated with systemic antibiotics (3.35, 0.65, and 0.41), p < 0.001; and with topical antibiotics (1.38, 0.55, and 0.32), p < 0.001. No major side effects were recorded. ConclusionsThe findings support the effectiveness and safety of nasal xylitol spray, for preventing recurrent AOM in children aged 1–4 years.