Vitamin D Levels in Children with Adenotonsillar Hypertrophy and Otitis Media with Effusion

Document Type: Original


1 Skull Base Research Center, ENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

2 ENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.


Vitamin D has been suggested to play a considerable role in the function of the immune system in various infectious, inflammatory, and autoimmune conditions. Otitis media with effusion (OME), defined as the presence of non-purulent fluid within the middle ear without signs or symptoms of suppurative otitis media, has a number of inflammatory predisposing factors. This study was designed to explore the association between vitamin D deficiency and OME.
Materials and Methods:
In this cross-sectional study, 74 children aged 2–7 years with an obstructive indication for adenotonsillectomy were included. Patients were divided into two groups based on the need for ventilation tube insertion for OME. Thirty-two children were enrolled in the OME group and 42 in the control group. The mean vitamin D level was compared between the two groups.
Mean vitamin D concentration in all patients was 11.96±5.85 ng/ml (9.79±4.36 ng/ml in the OME group and 13.61±6.33 ng/ml in the control group; P=0.003). There was also a significant difference in levels of vitamin D in patients referred in winter (9.0±2.94 ng/ml) compared with the summer (19.85±4.21 ng/ml; P=0.001). Data analyzed based on the season in which the patients were referred showed no significant difference between the OME and the control group.
Although our results showed lower serum levels of vitamin D in OME patients, the difference was not significant when seasons were taken into consideration. Therefore, the season is an important confounding factor in any research related to vitamin D due to the effect of sun-induced vitamin D.


Main Subjects

1. Antal ASDombrowski YKoglin SRuzicka TSchauber J. Impact of vitamin D3 on cutaneous immunity and antimicrobial peptide expression. Dermatoendocrinol. 2011; 3(1):18–22.

2. Campbell YFantacone MLGombart AF. Regulation of antimicrobial peptide gene expression by nutrients and by-products of microbial metabolism. Eur J Nutr. 2012; 51(8):899–907.

3. Canning MO, GrotenhuisK, de Wit H, Ruwhof C, Drexhage HA. 1-alpha, 25- Dihydroxyvitamin D3 (1, 25(OH) (2) D (3)) hampers the maturation of fully active immature dendritic cells from monocytes. Eur J Endocrinol. 2001; 145:351–7.

4. Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009; 63(4):473–7.

5. Aydın S, Aslan I, Yıldız I, Ağaçhan B, Toptaş B, Toprak S, et al. Vitamin D levels in children with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol. 2011; 75(3):364–7.

6. Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol. 2008; 37(1):113–9.

7. Agmon-Levin NTheodor ESegal RMShoenfeld Y. Vitamin D in systemic and organ-specific autoimmune diseases. Clin Rev Allergy Immunol. 2013; 45(2):256–66.

8. Boonstra A, Barrat FJ, Crain C, Heath VL, Savelkoul HF, O'Garra A. 1alpha, 25-Dihydroxyvitamin d3 has a direct effect on naive CD4 (+) T cells to enhance the development of Th2 cells. J Immunol. 2001; 167(9):4974–80.

9. Mahon BD, Wittke A, Weaver V, Cantorna MT. The targets of vitamin D depend on the differentiation and activation status of CD4 positive T cells. J Cell Biochem. 2003; 89(5):922-32.

10. Amestejani M, Seyed Salehi B, Vasigh M, Sobhkhiz A, Karami M, Alinia H, et al. Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study. J Drugs Dermatology. 2012; 11(3); 327–30.

11. Adorini L, Penna G, Giarratana N, Roncari A, Amuchastegui S, Daniel KC, et al. Dendritic cells as key targets for immunomodulation by Vitamin D receptor ligands. J Steroid Biochem Mol Biol. 2004; 89–90(1–5):437–41.

12. Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc11.

13. Capaccio P, Torretta S, Marciante GA, Marchisio P, Forti S, Pignataro L. Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss. Clin Exp Otorhinolaryngol. 2016; 9(1):33–8.

14. Damm MJayme KPKlimek L. Recurrent otitis media with effusion in childhood: when should an otolaryngologist consider an allergic etiology? HNO. 2013; 61(10):843–8.

15. Lannon C, Peterson LE, Goudie A. Quality measures for the care of children with otitis media with effusion. Pediatrics. 2011; 127(6): 1490–7.

16. Stol KVerhaegh SJGraamans KEngel JASturm PDMelchers WJ, et al. Microbial profiling does not differentiate between childhood recurrent acute otitis media and chronic otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2013; 77(4): 488–93.

17. Ameli F, Brocchetti F, Semino L, Fibbi A. Adenotonsillectomy in obstructive sleep apnea syndrome. Proposal of a surgical decision-taking algorithm. Int J Pediatr Otorhinolaryngol. 2007; 71: 729–34.

19. Rosenfeld RMCulpepper LDoyle KJGrundfast KMHoberman AKenna MA, et al. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg. 2004; 130(5 Suppl): 95–118

18. Onusko E. Tympanometry. Am Fam Physician. 2004; 70(9):1713–20.

20. Thacher TDClarke BL. Vitamin D insufficiency. Mayo Clin Proc. 2011; 86(1):50–60.

21. Esposito S, Lelii M. Vitamin D and respiratory tract infections in childhood.  BMC Infect Dis. 2015; 15:487.

22. Bergman PNorlin ACHansen SBjörkhem-Bergman L. Vitamin D supplementation to patients with frequent respiratory tract infections: a post hoc analysis of a randomized and placebo-controlled trial. BMC Res Notes. 2015; 8:391.

23. Cayir A, Turan M.I, Ozkan O, Cayir Y, Kaya A, Davutoglu S. Serum vitamin D levels in children with recurrent otitis media. Eur Arch Otorhinolaryngol. 2013; 013: 2455–7.

24. Marchisio PConsonni DBaggi EZampiero ABianchini STerranova L, et al. Vitamin D Supplementation Reduces the Risk of Acute Otitis Media in Otitis Prone Children. Pediatr Infect Dis J. 2013; 32(10):1055-60.

25. Linday LA, Shindledecker RD, Dolitsky JN, Chen TC, Holick MF. Plasma 25-hydroxyvitamin D levels in young children undergoing placement of tympanostomy tubes. Ann Otol Rhinol Laryngol. 2008; 117(10):740–4.

26. Moan J, Porojnicu AC, Dahlback A, Setlow RB. Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci USA. 2008; 105(2):668–73.

27. Robsahm TETretli SDahlback AMoan J. Vitamin D3 from sunlight may improve the prognosis of breast-, colon- and prostate cancer (Norway). Cancer Causes Control. 2004; 15(2):149-58.

28. Porojnicu AC1, Robsahm TEDahlback ABerg JPChristiani DBruland OSet al. Seasonal and geographical variations in lung cancer prognosis in Norway. Does Vitamin D from the sun play a role? Lung Cancer. 2007; 55(3):263–70.

29. McCarty DE, Chesson Jr AL, Jain SK, Marino AA. The link between vitamin D metabolism and sleep medicine. Sleep Medicine Reviews. 2013; 18 (4): 311–9.

30. Reid D, Morton R, Salkeld L, Bartley J. Vitamin D and tonsil disease preliminary observations. Int J Pediatr Otorhinolaryngol. 2011; 75(2):261-4.

31. Nunn JDKatz DRBarker SFraher LJHewison MHendy GNet al. Regulation of human tonsillar T-cell proliferation by the active metabolite of vitamin D3. Immunology. 1986; 59(4):479-84.

32. Ardestani PMSalek MKeshteli AHNejadnik HAmini MHosseini SM, et al. Vitamin D status of 6- to 7-year-old children living in Isfahan, Iran. Polish Journal of Endocrinology. 2010; 61(4): 377–81