The increases in otitis media, sinusitis, allergies, and asthma in the western world since the early 1970s seem best explained by our use of antihistamines and decongestants that dates from the same time. Although these drugs have purposes that seem worthwhile, such as reducing symptoms and shrinking membranes to allow easier draining, it is equally clear that their effect is to shut down the washing of the nasopharynx. Svensson and colleagues5 point out that the exudate of plasma triggered by histamine is a defensive physiologic attempt to remove pathogenic and allergenic irritants from the nasopharynx. A better solution would be to try to assist the immune system with this washing.
For the past 3 years I have been using xylitol in a nasal spray for my patients. My experience has been very positive, with a 93% reduction in chronic otitis and significant reductions in sinusitis, allergies, and asthma when this spray is used regularly. Like Dr. Hickner, I usually give a backup prescription when I see someone with acute problems, but most often patients tell me that frequent use of the spray clears their nasal passages better than anything they have ever used.
Xylitol is a food with pronounced drug effects. It is a weakness in our current system that we have no category of “foods with drug effects.” The nasal administration of this sugar-like food seems an excellent means of assisting the immune system to wash the nose. But there is no financially sound means or pharmaceutical interest in making this uncontrolled, readily available food into a drug.
Lon Jones, DO
Texas Tech University Medical School
Hale Center
- Kontiokari T, Uhari M, Koskela M. Antiadhesive effects of xylitol on otopathogenic bacteria. J Antimicrobial Chemother 1998; 41:563-65.
- Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double blind randomized trial. BMJ 1996; 313:1180-84.
- Uhari M, Kontiokari T, Niemela M. A novel use of xylitol sugar in preventing acute otitis media. Pediatrics 1998; 102:879-84.
- Zabner J, Seiler MP, Launspach JL, et al. The osmolyte xylitol reduces the salt concentration of airway surface fluid and may enhance bacterial killing. Proc Natl Acad Sci USA 2000; 10:97:11614-19.
- Svensson C, Andersson M, Greiff L, Persson CG. Nasal mucosal endorgan hyperresponsiveness. Am J Rhinol 1998; 12:37-43.
The preceding letter was referred to Dr Hickner who responded as follows:
Yesterday a 44-year-old man with a 4-day history of congestion, malaise, sore throat, and cough came to my office complaining of a sinus infection, similar to the other 2 sinus infections he had had during the past 3 years. Inspired by the research of Alho and colleagues1 and Hansen and coworkers,2 I carefully asked about his symptoms and dutifully examined him. One of his previous episodes sounded to me like true bacterial sinusitis with persistent symptoms of facial pain and nasal discharge for longer than 1 month. He was treated for that episode with an antibiotic and recovered rapidly. The second episode he described was of shorter duration, seemed less like bacterial sinusitis, and was treated with an antibiotic and experienced a rapid resolution of his symptoms.
What was I to do this time? To my surprise, when I explained that his symptoms were not typical of bacterial sinusitis, but rather of a nonspecific viral upper respiratory infection, he readily accepted my explanation and advice to call in 5 days if not improving or getting worse. The encounter lasted only 10 minutes. I believe he was satisfied, and I felt like an evidence-based physician that morning.
Yes, I agree with Dr Smith. We ought to disregard past history of sinusitis and judge each episode on its own merits.
Dr Jones suggests that xylitol nasal spray may be an excellent alternative to antibiotic treatment of otitis media and sinusitis. This sounds like a terrific hypothesis to test in a randomized clinical trial. Although pharmaceutical companies may not be interested in sponsoring such a study, the Agency for Healthcare Research and Quality certainly would if the trial were well designed.
John Hickner, MD, MS
Michigan State University
East Lansing
- Alho O, Ylitalo K, Kalevi J, et al. The common cold in patients with a history of recurrent sinusitis: increased symptoms and radiologic sinusitislike findings. J Fam Pract 2001; 50:26-31.
- Hansen JG, Schmidt H, Rosborg J, Lund E. Predicting acute maxillary sinusitis in a general practice population. BMJ 1995; 311:233-36.