Role of serum vitamin D levels in patients with chronic tonsillitis in paediatric age group


  • Pallavi Saroch Department of Otolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India
  • Aditya Saraf Department of Otolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India
  • Vikas Mahajan Department of Paediatrics, ASCOMS, Jammu, Jammu and Kashmir, India
  • Gopika Kalsotra Department of Otolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India
  • Parmod Kalsotra Department of Otolaryngology and Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India



Vitamin D, Tonsillitis, Serum


Background: Vitamin D has got an important role in the defence system of our body. Objective were to assess the vitamin D levels in chronic tonsillitis and to find the association between the vitamin D deficiency and chronic tonsillitis in paediatric age group.

Methods:  A total of 325 patients aged between 5 and 15 years were enrolled in this study who were diagnosed with recurrent tonsillitis between January 2021 and December 2022. The patients were followed-up for one year and the total episodes of acute tonsillitis were recorded. Patients were divided into three groups: Those who had <5 episodes per year (Group 1), those with >5 episodes per year (Group 2) in the last two years, those who come to OPD with otological complaint, with no tonsillar involvement as a control group (Group 3). The total number of recurrent tonsillitis episodes within one year, demographic characteristics and the mean serum 25 (OH) D levels of the groups were compared. 

Results: The tonsil size according to the Brodsky Scale and the mean 25 (OH) D levels were compared and we found, lower vitamin D levels were significantly associated with larger tonsil sizes (p=0.023).

Conclusions: There is a statistically significant association between vitamin D levels and recurrent episodes of tonsillitis. As the grade of tonsillar enlargement increased, the level of vitamin D were reduced significantly, thus correlating vitamin D levels not only with recurrence, but also grade of tonsillar enlargement.



Muhe L, Lulseged S, Mason KE, Simoes EA. Case-control study of the role of nutritional rickets in the risk of developing pneumonia in Ethiopian children. Lancet. 1997;349:1801-4.

Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab. 2009;94:26-34.

Yim S, Dhawan P, Ragunath C, Christakos S, Diamond G. Induction of cathelicidin in normal and CF bronchial epithelial cells by 1, 25-D3. J Cyst Fibros. 2007;6:403-10.

Wayse W, Yousafzai A, Mogale K, Filteau S. Association of subclinical dihydroxivitamin vitamin D deficiency with severe acute lower respiratory tract infections in Indian children under 5 years. Eur J Clin Nutr. 2004;58:563-7.

Hughes DA, Norton R. Vitamin D and respiratory health. Clin Exp Immunol. 2009;158:20-25.

Ginde AA, Mansbach JM, Camargo CA. Jr Association between serum 25-hydroxy vitamin D level and upper respiratory tract infection in the third national health and nutrition examination survey. Arch Intern Med. 2009;169:384-90.

Reichel H, Koeffler HP, Bishop JE, Norman AW. 25-Hydroxyvitamin D3 metabolism by lipopolysaccharidestimulated normal human macrophages. J Clin Endocrinol Metab. 1987;64:1-9.

Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311:1770-73.

Webber G, Heilborn JD, Chamorro Jimenez Cl, Hammarsjo A, Torma H, Stahle M. Vitamin D induces the antimicrobial protein hCAP18 in human skin. J Invest Dermatal. 2005;124:1080-2.

Gombart AF, Borregaard N, Koeffler HP. Human cathelicidin antimicrobial peptide (CAMP) is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxy vitamin D3. FASEB J. 2005;19(9):1067-77.

Liu PT, Stenger S, Tang DH, Modlin RL. Cutting edge: vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. J Immunol. 2007;179:2060-3.

Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87:1080S-6.

Paradise JL, Bluestone CD, Colborn DK, Bernard BS, Rockette HE, Kurs-Lasky M. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics. 2002;110(1 Pt 1):7-15.

Nseir W, Mograbi J, Abu-Rahmeh Z, Mahamid M, Abu-Elheja O, Shalata A. The association between vitamin D levels and recurrent group A streptococcal tonsillopharyngitis in adults. Int J Infect Dis. 2012;16(10):e735-8.

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

Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: İmplications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr. 2005;135(2):317-22.

Holick MF. Calcium and vitamin D. Diagnostics and therapeutics. Clin Lab Med. 2000;20(3):569-90.

Brodsky L. Modern assessment of tonsils and adenoids. Pediatr Clin North Am. 1989;3:1551-69.

Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ et al. Clinical Practice Guideline: Tonsillectomy in Children (Update)-Executive Summary. Otolaryngol. Head Neck Surg. 2019;144:S1-30.

Cullen KA, Hall MJ, Golosinskiy A. Ambulatory Surgery in the United States, 2006; National Health Statistics Reports; National Center for Biotechnology Information: Bethesda, MD, USA. 2009.

Kazi MY, Aamir K, Rana MN, Farooq MA. Frequency of Vitamin D3Deficiency in Children Presenting with Frequent Sino-Pulmonary Infections. Pakistan Paediatr J. 2013;37(2):101-5.

Asghari A, Bagheri Z, Jalessi M, Salem MM. Vitamin D levels in children with adenotonsillar hypertrophy and Otitis media with effusion. Iran J Otorhinolaryngol. 2017;29(1):29-33.

Yildiz I, Unuvar E, Zeybek U. The role of vitamin D in children with recurrent tonsillopharyngitis. Ital J Pediatr. 2012;38:25.

Collak A. Serum vitamin D levels in children with recurrent tonsillopharyngitis. North Clin Istanbul. 2014;1(1):13-8.

Chromek M, Slamova Z, Bergman P. The antimicrobial peptide cathelicidin protects the urinary tract against invasive bacterial infection. Nat Med. 2006;12(6):636-41.

Akbar NA, Zacharek MA. Vitamin D: Immunomodulation of asthma, allergic rhinitis, and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2011;19:224-8.

Bartley J. Vitamin D, innate immunity and upper respiratory tract infections. J Laryngol Otol. 2010;124(5):465-9.

Ball SL, Siou GP, Wilson JA, Howard A, Hirst BH, Hall J. Expression and immunolocalization of antimicrobial peptides within human palatine tonsils. J Laryngol Otol. 2007;121(10):973-8.

Esteitie R, Naclerio RM, Baroody FM. Vitamin D levels in children undergoing adenotonsillectomies. Int J Pediatr Otorhinolaryngol. 2010;74(9):1075-7.

Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in school children. Am J Clin Nutr. 2010;91(5);1255-60.

Laaksi I, Ruohola JP, Mattila V, Auvinen A, Ylikomi T, Pihlajamaki H. Vitamin D supplementation for the prevention of macute respiratory tract infection: A randomized, double-blinded trial among young Finnish men. J Infect Dis. 2010;202(5):809-14.

Li-Ng M, Aloia JF, Pollack S. A randomized controlled trial of vitamin D3 supplementation for the prevention of symptomatic upper respiratory tract infections. Epidemiol Infect. 2009;137(10):1396-404.

Robertsen S, Grimnes G, Melbye H. Association between serum 25-hydroxyvitamin D concentration and symptoms of respiratory tract infection in a Norwegian population: The Tromsø Study. Public Health Nutr. 2014;17(47):780-6.

Aydın S, Aslan I, Yıldız I. Vitamin D levels in children with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol. 2011;75(3):364-7.






Original Research Articles