Skip to main content

Serum vitamin D levels in children with recurrent otitis media


The aims of this study were to evaluate serum vitamin D levels in cases of recurrent otitis media and investigate the effect of vitamin D therapy on the risk of re-occurrence of the disease. This prospective study was performed by comparing serum vitamin D levels in children with recurrent otitis media and healthy children. Eighty-four children between 1 and 5 years of age and diagnosed with recurrent otitis media were enrolled as the study group. One hundred-and-eight healthy children with similar demographic characteristics were enrolled as the control group. Patients were divided into groups according to their serum 25(OH) vitamin D levels. In patients with low initial serum vitamin D levels, vitamin D therapy was administered in addition to conventional treatment for otitis media. Mean serum 25(OH) vitamin D level in the study group was 11.4 ± 9.8 ng/mL Serum 25(OH) vitamin D levels were below 20 ng/mL in 69 % (n = 58) of cases in this group. In the control group, mean serum 25(OH) vitamin D level was 29.2 ± 13.9 ng/mL and was below 20 ng/mL in 30 % (n = 32) of cases. Comparison of serum 25(OH) vitamin D levels and PTH in the study and control groups revealed a statistically significant difference (p < 0.05). Treatment was initiated in cases diagnosed with vitamin D deficiency, and patients were followed up in due course. The only episodes detected over the course of 1-year follow-up were one attack in five patients and two attacks in two. We believe that co-administration of supplementary vitamin D together with conventional treatments is appropriate in the management of upper respiratory infections such as otitis media.

This is a preview of subscription content, access via your institution.


  1. Rothman R, Owens T, Simel DL (2003) Does this child have acute otitis media? J Am Med Assoc 290(12):1633–1640. doi:10.1001/jama.290.12.1633

    CAS  Article  Google Scholar 

  2. Shaikh N, Hoberman A, Kaleida PH, Rockette HE, Kurs-Lasky M, Hoover H, Pichichero ME, Roddey OF, Harrison C, Hadley JA, Schwartz RH (2011) Otoscopic signs of otitis media. Pediatr Infect Dis J 30(10):822–826. doi:10.1097/INF.0b013e31822e6637

    PubMed  Article  Google Scholar 

  3. Coker TR, Chan LS, Newberry SJ, Limbos MA, Suttorp MJ, Shekelle PG, Takata GS (2010) Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review. J Am Med Assoc 304(19):2161–2169. doi:10.1001/jama.2010.1651

    CAS  Article  Google Scholar 

  4. Casselbrant ML, Kaleida PH, Rockette HE, Paradise JL, Bluestone CD, Kurs-Lasky M, Nozza RJ, Wald ER (1992) Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J 11(4):278–286

    CAS  PubMed  Article  Google Scholar 

  5. Karatekin G, Kaya A, Salihoglu O, Balci H, Nuhoglu A (2009) Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 63(4):473–477. doi:10.1038/sj.ejcn.1602960

    CAS  PubMed  Article  Google Scholar 

  6. Muhe L, Lulseged S, Mason KE, Simoes EA (1997) Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet 349(9068):1801–1804. doi:10.1016/S0140-6736(96)12098-5

    CAS  PubMed  Article  Google Scholar 

  7. Najada AS, Habashneh MS, Khader M (2004) The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr 50(6):364–368. doi:10.1093/tropej/50.6.364

    PubMed  Article  Google Scholar 

  8. Hughes DA, Norton R (2009) Vitamin D and respiratory health. Clin Exp Immunol 158(1):20–25. doi:10.1111/j.1365-2249.2009.04001.x

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  9. Walker VP, Modlin RL (2009) The vitamin D connection to pediatric infections and immune function. Pediatr Res 65(5 Pt 2):106R–113R. doi:10.1203/PDR.0b013e31819dba91

    PubMed Central  PubMed  Article  Google Scholar 

  10. Aydin S, Aslan I, Yildiz I, Agachan B, Toptas B, Toprak S, Deger K, Oktay MF, Unuvar E (2011) Vitamin D levels in children with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol 75(3):364–367. doi:10.1016/j.ijporl.2010.12.006

    PubMed  Article  Google Scholar 

  11. Linday LA, Shindledecker RD, Dolitsky JN, Chen TC, Holick MF (2008) Plasma 25-hydroxyvitamin D levels in young children undergoing placement of tympanostomy tubes. Ann Otol Rhinol Laryngol 117(10):740–744

    PubMed  Google Scholar 

  12. Del Castillo Martin F, Baquero Artigao F, de la Calle Cabrera T, Lopez Robles MV, Ruiz Canela J, Alfayate Miguelez S, Moraga Llop F, Cilleruelo Ortega MJ, Calvo Rey C (2012) Consensus document on the aetiology, diagnosis and treatment of acute otitis media. Anales de pediatria 77(5):345e341–348. doi:10.1016/j.anpedi.2012.05.026

    Google Scholar 

  13. Alho OP, Koivu M, Sorri M, Rantakallio P (1990) Risk factors for recurrent acute otitis media and respiratory infection in infancy. Int J Pediatr Otorhinolaryngol 19(2):151–161

    CAS  PubMed  Article  Google Scholar 

  14. American academy of pediatrics subcommittee on management of acute otitis media (2004) Diagnosis and management of acute otitis media. Pediatrics 113(5):1451–1465

    Article  Google Scholar 

  15. Ozkan B (2010) Nutritional rickets. J Clin Res Pediatr Endocrinol 2(4):137–143. doi:10.4274/jcrpe.v2i4.137

    PubMed Central  PubMed  Article  Google Scholar 

  16. Mutlu A, Mutlu GY, Ozsu E, Cizmecioglu FM, Hatun S (2011) Vitamin D deficiency in children and adolescents with type 1 diabetes. J Clin Res Pediatr Endocrinol 3(4):179–183. doi:10.4274/jcrpe.430

    PubMed Central  PubMed  Google Scholar 

  17. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M (2008) Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 122(2):398–417. doi:10.1542/peds.2007-1894

    PubMed  Article  Google Scholar 

  18. Bikle D (2009) Nonclassic actions of vitamin D. J Clin Endocrinol Metab 94(1):26–34. doi:10.1210/jc.2008-1454

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  19. Holick MF (2010) Vitamin D: extraskeletal health. Endocrinol Metab Clin North Am 39(2):381–400. doi:10.1016/j.ecl.2010.02.016

    CAS  PubMed  Article  Google Scholar 

  20. Akin L, Kurtoglu S, Yildiz A, Akin MA, Kendirici M (2010) Vitamin D deficiency rickets mimicking pseudohypoparathyroidism. J Clin Res Pediatr Endocrinol 2(4):173–175. doi:10.4274/jcrpe.v2i4.173

    PubMed Central  PubMed  Article  Google Scholar 

  21. Canning MO, Grotenhuis K, de Wit H, Ruwhof C, Drexhage HA (2001) 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 145(3):351–357

    CAS  PubMed  Article  Google Scholar 

  22. Manolagas SC, Hustmyer FG, Yu XP (1990) Immunomodulating properties of 1,25-dihydroxyvitamin D3. Kidney Int Suppl 29:S9–S16

    CAS  PubMed  Google Scholar 

  23. Lyakh LA, Sanford M, Chekol S, Young HA, Roberts AB (2005) TGF-beta and vitamin D3 utilize distinct pathways to suppress IL-12 production and modulate rapid differentiation of human monocytes into CD83+ dendritic cells. J Immunol 174(4):2061–2070

    CAS  PubMed  Google Scholar 

  24. Adams JS (2006) Vitamin D as a defensin. J Musculoskelet Neuronal Interact 6(4):344–346

    CAS  PubMed  Google Scholar 

  25. Jartti T, Ruuskanen O, Mansbach JM, Vuorinen T, Camargo CA Jr (2010) Low serum 25-hydroxyvitamin D levels are associated with increased risk of viral coinfections in wheezing children. J Allergy Clin Immunol 126(5):1074–1076. doi:10.1016/j.jaci.2010.09.004 1076 e1071–e1074

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  26. Yim S, Dhawan P, Ragunath C, Christakos S, Diamond G (2007) Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxyvitamin D(3). J Cyst Fibros 6(6):403–410. doi:10.1016/j.jcf.2007.03.003

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  27. Wayse V, Yousafzai A, Mogale K, Filteau S (2004) Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. Eur J Clin Nutr 58(4):563–567. doi:10.1038/sj.ejcn.1601845

    CAS  PubMed  Article  Google Scholar 

  28. Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E (2006) Epidemic influenza and vitamin D. Epidemiol Infect 134(6):1129–1140. doi:10.1017/S0950268806007175

    CAS  PubMed Central  PubMed  Article  Google Scholar 

Download references


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

All authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Atilla Cayir.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cayir, A., Turan, M.I., Ozkan, O. et al. Serum vitamin D levels in children with recurrent otitis media. Eur Arch Otorhinolaryngol 271, 689–693 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Child
  • Otitis media
  • Vitamin D
  • Therapy