Xylitol for Otitis Media

Inclusion Criteria: * Between 6 months and 3 years of age. * Clinical diagnosis of OME. Treated at Duke for the above condition. * Ability of parent/guardian to be compliant with at-home nasal spray administration. Exclusion Criteria: * History of immunodeficiency or an immunologic disorder that predisposes to frequent infections. * History of prior pressure-equalization (PE) tube placement and the tubes are still in place. * Active or recent (\<1 month prior to screening) middle ear disease, including but not limited to: cholesteatoma, tympanic membrane perforation, congenital external or middle ear abnormalities or malformations. * History of previous otologic surgery including tympanoplasty, and/or mastoidectomy. * Previous use of intranasal sprays other than normal saline, including intranasal steroids, and/or xylitol within 1 month prior to screening. * Any other clinically significant illness or medical condition, per PI discretion, that would prohibit the subject from participating in the study. * Subject has previously been randomized to a trial of Xylitol. * Parent/guardian is unable to administer the study nasal spray. * Parent/guardian is unable to read, write, and understand English. * Parent/guardian is unable to provide legally effective consent.