Xylitol: it’s not just an alternative sweetener or used in chewing gum and toothpaste to prevent cavities. This compound can reduce dental cavities and has been going mainstream regarding dental health for a while, but very few people are aware that the same principal of it keeping bacteria and bacterial biofilms at bay also applies to the sinuses and ears. It has been proven to reduce the symptoms of chronic sinus inflammation and ear infections in adults and children. With allergy season right around the corner, xylitol nasal spray and nasal irrigation is definitely something that may give you much needed, gentle relief.
Xylitol has been added to a saline nasal spray in a product called Xlear. It’s not like other saline nasal sprays that you may have used in the past which may not have worked or may have stung your nose. Xlear’s formula includes Xylitol and all-natural saline and grapefruit seed extract (which is used as a natural preservative). Xylitol nasal sprays do not sting, and they are non-habit forming, so unlike decongestant, antihistamine, or steroid nasal spray, you can use it as often as needed.
What’s the science behind this?
Xylitol is an alternative sweetener that is technically not artificial, but it often gets lumped in the category of artificial sweeteners. It is a sugar alcohol that naturally occurs in some fruit, vegetables, mushrooms, berries, endives, yellow plums, and strawberries. It is most often sourced from birch trees or corncobs. It is also produced in the human body as a metabolic by-product and can be found in the body’s tissues.
Most often known as a sugar alternative, xylitol’s chemical structure is different than glucose, fructose, or sorbitol. It has the same sweetness as table sugar but only has 40% of the calories that table sugar has (1). Still, why is a sugar alternative a remedy for sinus and ear afflictions?
To understand how it works for the sinuses and ears, we have to look at why it works for the mouth and dental health.
Xylitol and the Mouth
The bacteria and yeast that you can find in the mouth and on the dental biofilms which lead to cavities thrive on regular sugar. These same microorganisms can’t use xylitol, and if you take away their source of nutrients, the population declines. Xylitol also keeps bacteria from using it to ferment and produce their by-products: acids. Xylitol has been implicated for dental use since the 1970s in Finland (1). If you haven’t checked out the benefits of chewing xylitol gum or mints after meals when you’re on the go instead of brushing, or how xylitol toothpaste and mouthwash can improve your dental health, take some time to look into it—especially if you’re cavity prone.
Xylitol and the Nose and Sinuses
For allergy sufferers, those with chronic sinus infections and ear infections, xylitol works in much the same way as it does with the bacteria in the mouth. The same bacterial biofilm is found in cases of chronic nasal and sinus inflammation (rhinosinusitis). Xylitol, combined with saline, disrupts the biofilm of the bacteria Staphylococcus aureus and Pseudomonas aeruginosa, reduces the growth of S. aureus, P. aeruginosa, and S. epidermis (2).
In layman’s terms, it inhibits the growth of certain bacteria in the nasal passage, and it actually contains anti-adhesive properties: meaning it keeps germs or allergens from sticking to the lining of the nose and sinuses. Xylitol also stimulates the body’s own immune system (3).
In a 2012 study, it was found to relieve symptoms of chronic rhinosinusitis better than saline spray and irrigation (4).
Xylitol and the Ears
The bacteria that causes ear infections actually begins in the mouth, nose, and sinuses. The anti-adhesive properties of xylitol keep bacteria from traveling to the ears where it can colonize and cause infections of the middle ear (5).
Children are most at risk for ear infections because the shape of their eustachian tubes does not allow for drainage of the fluid and bacteria that can be built up inside the middle ear. When children grow, their eustachian tubes elongate and don’t form a hard angle anymore which allows the fluid to drain better as it resembles more of the shape of an adult eustachian tube. Xlear offers their xylitol nasal spray for children to help solve this issue.
As a parent of a child with chronic ear infections who also had the ear tubes placed at two years old, I have been around that block. I didn’t know about xylitol nasal spray and how it could help prevent ear infections back then, but after seeing the research for myself, I wish I had known about it sooner. A 2015 study surveyed parents and found that it was not well-known as an alternative solution for preventing ear infections, but the parents of children who battled ear infections would be more likely to try it than parents of children who did not suffer from ear infections (5).
Here’s some of the research about xylitol and ear infections:
In 2016, a study discovered that xylitol (in any form) reduces the risk of acute ear infections (otitis media=middle ear) by 8% in children under 12. Healthy children given xylitol chewing gum or lozenges had a 34% decrease in risk of acute ear infections (6).
In 2011, administering xylitol to healthy children who went to day care reduced their risk of ear infections by 25% (7).
Why do I use Xlear Nasal Spray?
Xlear nasal spray is a staple in my household during allergy season or when there’s a bad cold going around. I see effects usually within the same day after starting it.
Xlear is different than other nasal sprays because it is also made to be hypertonic. The tonicity of a solution refers to if it mimics the exact environment of the body or if it differs by drawing fluids in or out of the cells and tissues. Most saline nasal sprays are made to be isotonic, keeping the saline the same value as the body’s fluids and tissues. Xlear is hypertonic, meaning that it allows more moisture inside the tissues than regular saline nasal spray. This leads to lubricated nasal passages which helps provide valuable moisture to the nasal tissue and can reduce inflammation (8).
One of the biggest reasons I am comfortable using and giving my family Xlear nasal spray is that it is gentle and does not contain any habit-forming nasal decongestants. Using decongestant or steroid nasal sprays can lead to rebound effects where there is a risk of dependence upon nasal sprays, which is why saline nasal sprays are recommended for long-term use. To me, Xlear is a superior saline nasal spray that can reduce bacteria at the same time, so I choose it over saline nasal spray.
It comes in both an adult and child formula, but the only real difference between the two that I see is the shape of the bottle, nozzle, and the volume at which the spray comes out. The fact that the ingredients and formula appear to be the same for both adults and children is reassuring that I am also taking something gentle enough for a child. (I have used the adult bottle with my family and found that the speed and volume that sprays out from the adult version is too much for a child’s nose, however, so I would stick with the children’s version for children.)
Give Xlear Nasal Spray a try if you’re prone to allergies or ear infections this spring and see if it makes a difference for you.
1. “Xlear FAQ.” https://xlear.com/xlear/faq#what_is_xylitol.
2. Jain, R, et al. “The in Vitro Effect of Xylitol on Chronic Rhinosinusitis Biofilms.” Rhinology, vol. 54, no. 4, 1 Dec. 2016, pp. 323–328., doi:10.4193/Rhin15.380.
3. Sakallioglu, O, et al. “Xylitol and Its Usage in ENT Practice.” J Laryngol Otol., vol. 128, no. 7, July 2014, pp. 580–585., doi:10.1017/S0022215114001340.
4. Weissman, JD, et al. “Xylitol Nasal Irrigation in the Management of Chronic Rhinosinusitis: a Pilot Study.” Laryngoscope, vol. 121, no. 11, Nov. 2011, pp. 2468–72., doi:10.1002/lary.22176.
5. Danhauer, JL, et al. “Will Parents Participate in and Comply with Programs and Regimens Using Xylitol for Preventing Acute Otitis Media in Their Children?” Lang Speech Hear Serv Sch., vol. 46, no. 2, Apr. 2015, pp. 127–40., doi:10.1044/2015_LSHSS-14-0048.
6. Azarpazhooh, A, et al. “Xylitol for Preventing Acute Otitis Media in Children up to 12 Years of Age.” Cochrane Database Syst Rev., vol. 8, no. CD007095, 3 Aug. 2016, doi:10.1002/14651858.CD007095.pub3.
7. Azarpazhooh, A, et al. “Xylitol for Preventing Acute Otitis Media in Children up to 12 Years of Age.” Cochrane Database Syst Rev., vol. 11, no. CD007095, 9 Nov. 2011, doi:10.1002/14651858.CD007095.pub2.
8. “Xlear Nasal Spray Founder Nate Jones on CNBC's Squawk Box.” https://xlear.com/xlear/blog/blog/xlear-nasal-spray-founder-nate-jones-cnbcs-squawk-box/