Introduction
Otitis media with effusion (OME) is a condition in which the middle ear contains fluid but without any signs or symptoms of an acute infection. It may occur following an upper respiratory tract infection or spontaneously due to poor eustachian-tube function.1
Finkelstein et al.2 found that the incidence of adult-onset OME is far less than in children, and that it commonly follows rhinosinusitis, nasopharyngeal lymphatic tissue hypertrophy, and smoking, resulting in an inflammation of the eustachian tube lumen.3 According to our electronic database, an average of 100 patients per year were diagnosed with OME at our clinic during 2011–2016. Of those, 50%–60% were aged 12 years or older.
OME and eustachian tube dysfunction lead to hearing impairments ranging from normal hearing to a moderate hearing loss (0–55 dB HL), with an average hearing threshold of 28 dB.1 In addition, chronic OME without treatment may result in retraction of the tympanic membrane, atelectatic ear, ossicular erosion, tympanic membrane perforation, or even cholesteatoma formation.1,4Therefore, patients with OME should receive proper management in order to prevent such complications.
Regarding the results from previous literature, conservative treatment by medical therapies (such as antihistamines, decongestants, antireflux therapy, and topical nasal steroids) is ineffective in both the short and long term.5
As for adult OME, the aim of treatment is to eliminate the cause of eustachian tube dysfunction and to restore eustachian tube function. Swallowing and chewing are two possibilities that can help to recover normal tube function. Nevertheless, no previous studies have investigated the relationship between the applicable use of gum-chewing and OME in adults.
Gum-chewing activates jaw movement and induces frequent swallowing. In the resting position, the eustachian tube is collapsed due to the passive effect of the cartilage, the elastic fibers, and the pressure of the surrounding tissues.6,7 In contrast, the activation of 2 peritubal muscles—the levator veli palatini and the tensor veli palatini—stimulates the swallowing mechanism, thereby opening the eustachian tube.8
Gum is easily obtained in the marketplace and is low-priced. It is made from the resin of a tree, to which a variety of ingredients, including xylitol, are added to sweeten its flavor. Xylitol has long been used in food, pharmaceutical, and oral-health products.9 It has minimal effect on blood sugar and insulin levels, with 40% fewer calories than regular gum and a low glycemic index. Xylitol is safe for consumption by diabetic patients.9