An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 13 , ISSUE 1 ( January-April, 2021 ) > List of Articles


Vitamin D Level in Children with Secretory Otitis Media

Yasser M Mandour, Mohammed Shendy, Safaa A Ramadan, Ayman A Mohammady, Samer Badae

Keywords : Adenoid hypertrophy, Otitis media, Vitamin D

Citation Information : Mandour YM, Shendy M, Ramadan SA, Mohammady AA, Badae S. Vitamin D Level in Children with Secretory Otitis Media. Int J Otorhinolaryngol Clin 2021; 13 (1):18-22.

DOI: 10.5005/jp-journals-10003-1366

License: CC BY-NC 4.0

Published Online: 29-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Vitamin D contains anti-inflammatory properties and plays a function in immune system regulation. Multiple investigations have proven the involvement of vitamin D deficiency in respiratory and middle ear infections. Aim: The goal of this study was to see how vitamin D levels in the blood affected the development of secretory otitis media (SOM) and adenoid hypertrophy. Patients and methods: This prospective case-control study included a total of 150 subjects who were divided into two groups; the case group included 100 confirmed cases of SOM and adenoid hypertrophy, and the control group included 50 healthy children. All cases and controls were subjected to complete history taking, thorough ENT examination, and tympanometry. In addition, serum vitamin D was ordered for all subjects. Results: The average age of the study participants was 7.65 years, which was significantly older than the control group (average age, 6.1; p = 0.002). However, there was no significant gender difference between the two groups (p = 1). The commonest season of presentation in the case group was winter (70%), while the remaining cases presented in summer. The season of the presentation was the difference between the two groups, and it was statistically significant (p = 0.017). Vitamin D levels in the cases were considerably lower (11.82 vs 23.72 ng/mL in the control group; p = 0.001). Using a cutoff value of 18.85, vitamin D had sensitivity and specificity of 100 and 90%, respectively, with a diagnostic accuracy of 96.7%. All cases showed hypertrophied adenoids on X-ray and type B tympanometry on tympanogram, while all controls showed normal-sized adenoids in addition to type A tympanogram. Conclusion: Our findings indicate that low vitamin D levels are associated with exudative SOM and enlarged adenoids. Therefore, in children with these symptoms, measuring serum 25 (OH) D levels should be investigated.

  1. Gombart AF, The vitamin D–antimicrobial peptide pathway and its role in protection against infection. Future Microbiol 2009;4(9): 1151–1165. DOI: 10.2217/fmb.09.87.
  2. Esposito S, Lelii M. Vitamin D and respiratory tract infections in childhood. BMC Infect Dis 2015;15(1):487. DOI: 10.1186/s12879-015-1196-1.
  3. Erdivanli OC, Coskun ZO, Kazikdas KC, et al. Prevalence of otitis media with effusion among Primary School Children in Eastern Black Sea, in Turkey and the effect of smoking in the development of otitis media with effusion. Indian J Otolaryngol Head Neck Surg 2012;64(1):17–21. DOI: 10.1007/s12070-011-0131-z.
  4. Bluestone CD, Stephenson JS, Martin LM. Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992;11(8 Suppl.):S7–S11. DOI: 10.1097/00006454-199208001-00002.
  5. Poe DS, Abou-Halawa A, Abdel-Razek O. Analysis of the dysfunctional eustachian tube by video endoscopy. Otol Neurotol 2001;22(5):590–595. DOI: 10.1097/00129492-200109000-00005.
  6. Bhat V, Bhandary SK, Shenoy V. Otitis media with effusion in relation to socio economic status: a community based study. Indian J Otolaryngol Head Neck Surg 2012;64(1):56–58. DOI: 10.1007/s12070-011-0163-4.
  7. Ashhurst-Smith C, Hall ST, Burns CJ, et al. In vitro inflammatory responses elicited by isolates of Alloiococcus otitidis obtained from children with otitis media with effusion. Innate Immun 2014;20(3):320–326. DOI: 10.1177/1753425913492181.
  8. Cayir A, Turan MI, Ozkan O, et al. Serum vitamin D levels in children with recurrent otitis media. Eur Arch Oto-Rhino-Laryngol 2014;271(4):689–693. DOI: 10.1007/s00405-013-2455-7.
  9. Marchisio P, Consonni D, Baggi E, et al. Vitamin D supplementation reduces the risk of acute otitis media in otitis-prone children. Pediatr Infect Dis J 2013;32(10):1055–1060. DOI: 10.1097/INF.0b013e 31829be0b0.
  10. Rovers M, Haggard M, Gannon M, et al. Heritability of symptom domains in otitis media: a longitudinal study of 1,373 twin pairs. Am J Epidemiol 2002;155(10):958–964. DOI: 10.1093/aje/155.10.958.
  11. Mithal A, Wahl DA, Bonjour J-P, et al. Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int 2009;20(11): 1807–1820. DOI: 10.1007/s00198-009-0954-6.
  12. McGill A, Stewart J, Lithander F, et al. Relationships of low serum vitamin D3 with anthropometry and markers of metabolic syndrome and diabetes in overweight and obesity. Obes Metab 2009;6(4):52–53. DOI: 10.1186/1475-2891-7-4.
  13. Timms P, Mannan N, Hitman G, et al. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 2002;95(12):787–796. DOI: 10.1093/qjmed/95.12.787.
  14. Sabetta JR, DePetrillo P, Cipriani RJ, et al. Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One 2010;5(6):e11088. DOI: 10.1371/journal.pone.0011088.
  15. Hosseini S, Khajavi M, Eftekharian A, et al. Vitamin D levels in children with otitis media with effusion: a case-control study. Thrita 2016;5(1). DOI: 10.5812/thrita.31977.
  16. Akcan FA, Dündar Y, Akcan HB, et al. Clinical role of vitamin D in prognosis of otitis media with effusion. Int J Pediatr Otorhinolaryngol 2018;105:1–5. DOI: 10.1016/j.ijporl.2017.11.030.
  17. Schleicher RL, Sternberg MR, Looker AC, et al. National estimates of serum total 25-hydroxyvitamin D and metabolite concentrations measured by liquid chromatography–tandem mass spectrometry in the US population during 2007–2010. J Nutr 2016;146(5):1051–1061. DOI: 10.3945/jn.115.227728.
  18. Smith M, Seasonal, ethnic and gender variations in serum vitamin D3 levels in the local population of Peterborough. Bioscience Horizons 2010;3(2):124–131. DOI: 10.1093/biohorizons/hzq016.
  19. Klingberg E, Oleröd G, Konar J, et al. Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort. Endocrine 2015;49(3):800–808. DOI: 10.1007/s12020-015-0548-3.
  20. Asghari A, Bagheri Z, Jalessi M, et al. Vitamin D levels in children with adenotonsillar hypertrophy and otitis media with effusion. Iran J Otorhinolaryngol 2017;29(90):29. PMID: 28229060, PMCID: PMC5307302.
  21. Hashemipour S, Larijani B, Adibi H, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 2004;4(1):38. DOI: 10.1186/1471-2458-4-38.
  22. Cayir A, Turan MI, Ozkan O, et al. Vitamin D levels in children diagnosed with acute otitis media. J Pak Med Assoc 2014;64(11):1274–1277. PMID: 25831645.
  23. Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab 2009;94(1):26–34. DOI: 10.1210/jc.2008-1454.
  24. Morcos M, Gabr A, Samuel S, et al. Vitamin D administration to tuberculous children and its value. Boll Chim Farm 1998;137(5): 157–164. PMID: 9689902.
  25. Szodoray P, Nakken B, Gaal J, et al. The complex role of vitamin D in autoimmune diseases. Scand J Immunol 2008;68(3):261–269. DOI: 10.1111/j.1365-3083.2008.02127.x.
  26. Muhe L, Lulseged S, Mason KE, et al. Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet 1997;349(9068):1801–1804. DOI: 10.1016/S0140-6736(96)12098-5.
  27. Yim S, Dhawan P, Ragunath C, et al. Induction of cathelicidin in normal and CF bronchial epithelial cells by 1, 25-dihydroxyvitamin D3. J Cyst Fibros 2007;6(6):403–410. DOI: 10.1016/j.jcf.2007.03.003.
  28. Cannell J, Vieth R, Umhau J, et al. Epidemic influenza and vitamin D. Epidemiol Infect 2006;134(6):1129–1140. DOI: 10.1017/S0950268806007175.
  29. Linday LA, Shindledecker RD, Dolitsky JN, et al. Plasma 25-hydroxyvitamin D levels in young children undergoing placement of tympanostomy tubes. Ann Otol Rhinol Laryngol 2008;117(10):740–744. DOI: 10.1177/000348940811701006.
  30. Nunn J, Katz D, Barker S, et al. Regulation of human tonsillar T-cell proliferation by the active metabolite of vitamin D3. Immunology 1986;59(4):479. PMID: 3026959, PMCID: PMC1453330.
  31. McCarty DE, Chesson Jr AL, Jain SK, et al. The link between vitamin D metabolism and sleep medicine. Sleep Med Rev 2014;18(4):311–319. DOI: 10.1016/j.smrv.2013.07.001.
  32. Reid D, Morton R, Salkeld L, et al. Vitamin D and tonsil disease–preliminary observations. Int J Pediatr Otorhinolaryngol 2011;75(2):261–264. DOI: 10.1016/j.ijporl.2010.11.012.
  33. Piovezan RD, Hirotsu C, Feres MC, et al. Obstructive sleep apnea and objective short sleep duration are independently associated with the risk of serum vitamin D deficiency. PLoS One 2017;12(7). DOI: 10.1371/journal.pone.0180901.
  34. Salepci B, Caglayan B, Nahid P, et al. Vitamin D deficiency in patients referred for evaluation of obstructive sleep apnea. J Clin Sleep Med 2017;13(04):607–612. DOI: 10.5664/jcsm.6554.
  35. San T, Muluk NB, Cingi C. 1,25(OH)2D3 and specific IgE levels in children with recurrent tonsillitis, and allergic rhinitis. Int J Pediatr Otorhinolaryngol 2013;77(9):1506–1511. DOI: 10.1016/j.ijporl.2013.06.019.
  36. Shin JH, Kim BG, Kim BY, et al. Is there an association between vitamin D deficiency and adenotonsillar hypertrophy in children with sleep-disordered breathing? BMC Pediatr 2018;18(1):196. DOI: 10.1186/s12887-018-1178-8.
  37. Anwar K, Khan S, ur Rehman H, et al. Otitis media with effusion: accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies. Pak J Med Sci 2016;32(2):466. DOI: 10.12669/pjms.322.9009.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.