Vitamin D, sometimes referred to as the “sunshine vitamin,” plays a role in various bodily functions, including bone health, immune system regulation, and inflammation reduction. An increasing amount of research supports the potential influence of vitamin D on a number of different ear, nose, and throat (ENT) conditions. The association between vitamin D levels and ENT health offers promising insights into preventative and therapeutic strategies for managing a range of conditions.

Which ENT conditions are associated with vitamin D deficiency?

1. Otitis Media (Middle Ear Infections)

Two common middle ear conditions in children are acute otitis media, and otitis media with effusion or “glue ear” which is characterised by persistent fluid or “glue” in the middle ear after an acute infection which can affect hearing. Both conditions have both been associated with low vitamin D levels. The effect is not huge, but nonetheless is significant. For example, kids with persistent glue ear as opposed to those who recover, are about 1.5 times more likely to have vitamin D deficiency. Adequate levels of vitamin D may enhance innate immunity and reduce the risk of bacterial colonization in the middle ear, thus lowering the likelihood of recurrent infections.

2. Sinusitis

A review of the relationship between vitamin D levels and chronic sinusitis concluded that chronic sinusitis patients are correlated with the lowest vitamin D levels, and increased severity of the disease, especially in those with nasal polyps. The review recommended checking vitamin D levels as part of the assessment for chronic sinusitis, and that patients with this condition may benefit from replacing vitamin D when levels are low. They also recognised that more well-designed clinical trials should be conducted for further validation of the findings.

3. Tonsillitis

A meta-analysis of a small number of publications showed significant reduction of vitamin D levels in patients with recurrent tonsillitis as compared to healthy control subjects. While this highlights that maintaining adequate vitamin D levels may be helpful to try and reduce episodes of recurrent tonsillitis, it also emphasised the need to explore these findings further with clinical trials based on large populations.

4. Hoarseness and throat symptoms

A preliminary study on the relationship between vitamin D levels and hoarseness and other throat symptoms showed a significant difference in the frequency of throat symptoms such as burning, aching, soreness and lump sensation in patients with vitamin D deficiency compared to those with no vitamin D deficiency.

However a review of the literature did not show a difference in voice quality between those with or without vitamin D deficiency.

5. Vertigo

A review published in 2022 of intervention studies demonstrated decrease in vertigo recurrence in patients with BPPV (benign paroxysmal postional vertigo) when subnormal vitamin D levels were treated with vitamin D supplementation. Although there is a lack of high-quality studies, the present literature highlights a role for optimization of vitamin D levels in patients with BPPV.

6. Obstructive sleep apnea

In a meta-analysis of twenty-nine eligible studies compromising 6717 participants, patients with moderate and severe OSA demonstrated lower vitamin D levels than subjects without OSA.

Simply because OSA is associated with lower vitamin D does not mean that low vitamin D is causing the OSA. For example, a person with severe OSA may also have poorer dietary habits or less sunlight exposure (tiredness from OSA can lead to less exercise), which may result in lower vitamin D.

7. Head & neck cancer

A systematic review in 2020 of published studies concluded that Vitamin D deficiency may be more common in head & neck cancer patients than in the healthy population. However there is no evidence vitamin D deficiency causes cancer, and further studies are needed to determine whether low vitamin D levels play a role in the development of head and neck cancers and their treatment outcome.

What does this mean to us?

The association between vitamin D and ENT conditions is an exciting area that is likely to be increasingly studied in the coming years.

Although vitamin D deficiency is associated with a number of ENT conditions, this does not mean that vitamin D deficiency is the cause of the condition. Likewise this also means that supplementing with vitamin D may be just one facet of the treatment.

Nonetheless, screening for vitamin D deficiency may be helpful in certain situations, such as recurrent ear infections, chronic sinusitis, throat symptoms that become persistent and troublesome, and certain types of dizziness. Vitamin D is not a cure for cancer but could contribute towards overall health and recovery. Supplementation with vitamin D, could sometimes enhance treatment of these conditions, alongside appropriate medical management, ultimately improving quality of life.

References

Akcan FA, Dündar Y, Akcan HB, Uluat A, Cebeci D, Sungur MA, Ünlü İ. Clinical role of vitamin D in prognosis of otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2018 Feb;105:1-5.

Pantazidou G, Papaioannou I, Skoulakis C, Petinaki E, Hajiioannou J. Vitamin D Levels in Chronic Rhinosinusitis in Patients With or Without Nasal Polyposis: A Systematic Review. Cureus. 2023 Sep 30;15(9):e46275.

Mirza AA, Alharbi AA, Marzouki H, Al-Khatib T, Zawawi F. The Association Between Vitamin D Deficiency and Recurrent Tonsillitis: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2020 Nov;163(5):883-891.

Hamdan AL, Fakhri G, Haddad G, Dunya G, Sarieddine D, Turfe B, Tabet G, Azar S. Effect of vitamin D deficiency on the laryngo-pharyngeal tract. Am J Otolaryngol. 2017 May-Jun;38(3):333-336. doi: 10.1016/j.amjoto.2017.02.001. Epub 2017 Feb 13. PMID: 28228242.

Hong X, Christ-Franco M, Moher D, Tse D, Lelli DA, Schramm D, Caulley L, Kontorinis G. Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review. Otol Neurotol. 2022 Aug 1;43(7):e704-e711.

Li X, He J, Yun J. The association between serum vitamin D and obstructive sleep apnea: an updated meta-analysis. Respir Res. 2020 Nov 9;21(1):294.

Mäkitie A, Tuokkola I, Laurell G, Mäkitie O, Olsen K, Takes RP, Florek E, Szyfter K, Sier CFM, Ferlito A. Vitamin D in Head and Neck Cancer: a Systematic Review. Curr Oncol Rep. 2020 Nov 20;23(1):5.