Otitis media (Ear Infection)

Overview

Xylitol (WA 72; medium effect size, high evidence, very high trust) has medium-strength evidence for otitis media prevention in preschool children. Chewing gum, lozenges, or syrup totaling about 8.4–10 grams daily in divided doses may reduce ear infection risk by roughly 25–40%, with gum and lozenges appearing most effective.

Olive Oil (WA 44; low effect size, low evidence, medium trust) ear drops did not reduce pain versus standard drops in one study. Echinacea (WA 48; low effect size, medium evidence, medium trust) and Vitamin D (WA 44; low effect size, low evidence, medium trust) have mixed or unclear evidence for prevention or treatment. See the heatmap and evidence reviews below.

Effect graph

Unlock now

Relevant supplements

Relevant supplements sorted by DEX Score.


Xylitol	★★★★★	Medium
Echinacea	★★★★★	Low
Vitamin D	★★★★★	Low
Olive Oil	★★★★★	Low

Unlock now

Studies

Find individual evidence reviews for supplements sorted by DEX Score.

4 supplements for and rated at least stars. All purchase bands. No minimum star filter.

XylitolView supplement →

Consider purchase★★★★★

How we scored this

Effect SizeMediumEvidenceHighTrustVery High

Evidence Review

Using xylitol chewing gum, lozenges, or syrup, may help lower the risk of ear infections in preschool children.
Studies show that a total of 8.4–10 grams of xylitol each day, divided into up to five doses after meals, can reduce the risk of ear infections by about 25% to 40%.
Gum and lozenges seem to work best, while syrup may help but to a lesser degree.
Some research also shows that xylitol users need fewer antibiotics.
However, one study found no benefit when giving xylitol syrup for six months, possibly because children took smaller amounts and ear infections were rare during the COVID-19 period.
Starting xylitol only after cold symptoms begin does not seem to prevent ear infections.
Early research suggests that using a nasal xylitol spray two or three times per day might help reduce ear infection episodes in young children.

Browse 7 studies2 meta-analyses

RCTXylitol for the prevention of acute otitis media episodes in children aged 1-5 years: a randomised controlled trial2024n=59

In an RCT of 59 participants, for 6 months, regular use of xylitol did not prevent AOM, URTIs or dental caries in a trial with limited statistical power.

Effect: No Benefit
Duration: 6 months
Population: Children/adolescents
Participants: 59
Ages: 1–5

View on PubMed

ObservationalXylitol nasal spray for prevention of recurrent acute otitis media in children: A prospective two-center cohort study2024n=68

In an observational study of 68 participants, for 3 months, the findings support the effectiveness and safety of nasal xylitol spray, for preventing recurrent AOM in children aged 1-4 years.

Effect: Benefit
Duration: 3 months
Population: Children/adolescents
Participants: 68
Ages: 1–4

View on PubMed

MetaXylitol for preventing acute otitis media in children up to 12 years of age2016n=3,405

In a meta-analysis of 3,405 participants, xylitol was not effective in reducing AOM among healthy children during a respiratory infection (RR 1.13, 95% CI 0.83 to 1.53; moderate quality evidence) or among otitis-prone healthy children (RR 0.90, 95% CI 0.67 to 1.21; low-quality evidence).

Effect: Benefit
Population: Children/adolescents
Participants: 3,405
Avg age: ~12

View on PubMed

MetaXylitol for preventing acute otitis media in children up to 12 years of age2011n=1,826

In a meta-analysis of 1,826 participants, among the reasons for drop-outs, there were no significant differences in abdominal discomfort and rash between the xylitol and the control groups.

Population: Children/adolescents
Participants: 1,826
Avg age: ~12

View on PubMed

RCTXylitol administered only during respiratory infections failed to prevent acute otitis media2002n=1,277

In an RCT of 1,277 participants, xylitol administered only during an ARI was ineffective in preventing AOM.

Effect: No Benefit
Duration: 4 months
Population: Children/adolescents
Participants: 1,277

View on PubMed

RCTA novel use of xylitol sugar in preventing acute otitis media1998n=179

In an RCT of 179 participants, 8.4–10 g xylitol/day, xylitol sugar, when given in a syrup or chewing gum, was effective in preventing AOM and decreasing the need for antimicrobials.

Effect: Benefit
Dose: 8.4–10 g/day
Population: Children/adolescents
Participants: 179

View on PubMed

RCTXylitol chewing gum in prevention of acute otitis media: double blind randomised trial1996n=306

In an RCT of 306 participants, 8.4 g/day, xylitol seems to have a preventive effect against acute otitis media.

Effect: Benefit
Duration: 2 months
Dose: 8.4 g/day
Population: Children/adolescents
Participants: 306
Avg age: 5±2

View on PubMed

EchinaceaView supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceMediumTrustMedium

Evidence Review

Echinacea taken by mouth or nose might lower the chance of ear infections in children by nearly half, but it does not help infections heal faster.
Some studies had mixed results, and in young children with frequent ear infections, echinacea did not prevent new infections and might even increase risk.
More research is needed before echinacea can be recommended for preventing or treating ear infections in children.

Browse 2 studies1 meta-analysis

MetaEfficacy and safety of Echinacea purpurea in treating upper respiratory infections and complications of otitis media in children: Systematic review and meta-analysis2025n=1,651

A meta-analysis of 9 pediatric RCTs (1,651 placebo, 1,518 treatment) found E. purpurea reduced URTI duration (SMD −0.19), incidence (RR 0.81), and antibiotic use (RR 0.18), and lowered otitis media episodes (RR 0.56), with mildly increased adverse events.

Effect: Benefit
Population: Children/adolescents
Participants: 1,651

View on PubMed

RCTEchinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomized controlled trial2008

In 90 otitis-prone children over 6 months, echinacea at cold onset increased acute otitis media risk (65% vs 41%; RR 1.59) versus placebo; osteopathic manipulation also did not significantly reduce risk.

Effect: No Benefit
Duration: 10 days
Population: Children/adolescents
Ages: 12–60

View on PubMed

Olive OilView supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceLowTrustMedium

Evidence Review

Using olive oil drops in the ear does not reduce pain in children with ear infections.
One study found that olive oil drops were no better than standard ear pain medicine drops.

Browse 1 study

RCTEfficacy of Auralgan for treating ear pain in children with acute otitis media1997n=54

In 54 children (ages 5–19) with acute otitis media ear pain on acetaminophen, Auralgan ear drops provided modestly greater pain relief than olive oil placebo by 30 minutes.

Effect: Benefit
Dose: 15 mg/kg
Population: Children/adolescents
Participants: 54
Ages: 5–19

View on PubMed

Vitamin DView supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceLowTrustMedium

Evidence Review

It is not clear if vitamin D affects middle ear infections (otitis media).
People with these infections tend to have lower vitamin D levels, but having low vitamin D does not seem to raise the chance of getting the infection.

Browse 2 studies

RCTVitamin D supplementation reduces the risk of acute otitis media in otitis-prone children2013n=116

In a 4-month RCT of 116 otitis-prone children, 1,000 IU/day vitamin D reduced the proportion experiencing acute otitis media episodes (26% vs 38%; P = 0.03).

Effect: Benefit
Duration: 6 months
Dose: 1000 IU/day
Population: Children/adolescents
Participants: 116

View on PubMed

RCTHigh doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial2012n=182

In a 1-year RCT of 182 COPD patients, 100,000 IU vitamin D every 4 weeks did not reduce exacerbation incidence versus placebo despite raising 25(OH)D.

Effect: No Benefit
Duration: 1 year
Dose: 100000 IU/day
Population: Osteoporosis patients
Participants: 182

View on PubMed

Unlock now

Evidence visualised

Same ratings as above, aggregated so you can see coverage and imbalance.

Purchase-guidance distribution

How many supplements fall in each purchase band

Effect-size distribution

How large the reported benefits tend to be

Study distribution across 4 supplements for otitis media (12 studies total).
Supplement	DEX	Studies	Meta-analyses	Share
Xylitol	★★★★★72%	7	2	58%
Echinacea	★★★★★48%	2	1	17%
Vitamin D	★★★★★44%	2	0	17%
Olive Oil	★★★★★44%	1	0	8%

Unlock now

Otitis media (Ear Infection)

Overview

Effect graph

Relevant supplements

Studies

Evidence visualised

On this page