European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 4, pp 1075–1080 | Cite as

Evaluation of nasal mucociliary clearance time in patients with Vitamin-D deficiency

  • Fatih Alper AkcanEmail author
  • Yusuf Dündar
  • Hümeyra Bayram Akcan
  • Ahmet Uluat
  • Derya Cebeci
  • İlhan Ünlü



The main purpose of the current study was to investigate nasal mucociliary clearance time (NMC) in patients with Vitamin-D deficiency.


A total of 55 patients with Vitamin-D deficiency and 32 controls were evaluated. NMC time was measured with subjective saccharine test and compared between study and control groups. In addition, NMC time was re-evaluated after Vitamin-D replacement protocol in patients with Vitamin-D deficiency.


The mean 25(HO)Vitamin-D levels were 14.32 ± 4.23 ng/mL (7–24.6) and 29.38 ± 7.05 ng/mL (25–53.8) in study and control groups, respectively (p < 0.001). The mean NMC time was 11.15 ± 3.05 (6.3–17.6) and 8.40 ± 2.33 (6–13.2) in study and control groups, respectively (p < 0.001). The mean 25(HO)Vitamin-D level after the replacement protocol was 33.38 ± 10.03 and the mean NMC time was 9.56 ± 2.54 (p < 0.001).


The mean NMC time was significantly increased in patients with Vitamin-D deficiency which can be corrected after Vitamin-D replacement protocols. The prolonged mucociliary clearance might be one of the pathophysiologic pathways at increased upper respiratory tract infections, and sinonasal and ear infections in patients with Vitamin-D deficiency.


Vitamin-D Nasal mucociliary clearance Upper respiratory tract infection Ear infection 



All authors would like to thank Dr. Uche Nwagu for her English revisions.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest regarding publication of this paper.

Ethical approval

This article contains studies with human participants and local ethics committee approval was obtained before the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Knowles MR, Boucher RC (2002) Mucus clearance as a primary innate defense mechanism for mammalian airways. J Clin Invest 109:571–577. CrossRefGoogle Scholar
  2. 2.
    Keles N (2003) Nazal spreylerde kullanilan benzalkonyum klorurun mukozal etkileri. Turk Arch Otolaryngol 41:31–35Google Scholar
  3. 3.
    Asai K, Haruna S, Otori N, Yanagi K, Fukami M, Moriyama H (2000) Saccharine test of maxillary sinus mucociliary function after endoscopic sinus surgery. Laryngoscope 110:117–122CrossRefGoogle Scholar
  4. 4.
    Kucur C, Ozbay I, Gulcan E, Kulekci S, Aksoy S, Oghan F (2016) Evaluation of nasal mucociliary activity in patients with chronic renal failure. Eur Arch Otorhinolaryngol 273:1167–1171. CrossRefGoogle Scholar
  5. 5.
    Soylu Özler G, Akbay E, Akkoca AN, Karapınar OS, Şimşek G (2015) Does menopause effect nasal mucociliary clearance time? Eur Arch Otorhinolaryngol 272:363–366. CrossRefGoogle Scholar
  6. 6.
    Uysal IO, Gokakın AK, Karakus CF, Deveci K, Hasbek Z, Sancakdar E (2013) Evaluation of nasal mucociliary activity in iatrogenic hypothyroidism. Eur Arch Otorhinolaryngol 270:3075–3078. CrossRefGoogle Scholar
  7. 7.
    Hewison M (2012) An update on Vitamin-D and human immunity. Clin Endocrinol (Oxf) 76:315–325. CrossRefGoogle Scholar
  8. 8.
    Edfeldt K, Liu PT, Chun R, Fabri M, Schenk M, Wheelwright M et al (2010) T-cell cytokines differentially control human monocyte antimicrobial responses by regulating Vitamin-D metabolism. Proc Natl Acad Sci USA 107:22593–22598. CrossRefGoogle Scholar
  9. 9.
    Bikle D (2009) Nonclassic actions of Vitamin-D. J Clin Endocrinol Metab 94:26–34. CrossRefGoogle Scholar
  10. 10.
    Hughes DA, Norton R (2009) Vitamin-D and respiratory health. Clin Exp Immunol 158:20–25. CrossRefGoogle Scholar
  11. 11.
    Walker VP, Modlin RL (2009) The Vitamin-D connection to pediatric infections and immune function. Pediatr Res 65:106R–113R. CrossRefGoogle Scholar
  12. 12.
  13. 13.
    Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77:204–210CrossRefGoogle Scholar
  14. 14.
    Deitmer T (1989) Physiology and pathology of the mucociliary system. Special regards to mucociliary transport in malignant lesions of the human larynx. Adv Otorhinolaryngol 43:1–136Google Scholar
  15. 15.
    Sun SS, Hsieh JF, Tsai SC, Ho YJ, Kao CH (2000) The role of rhinoscintigraphy in the evaluation of nasal mucociliary clearance function in patients with sinusitis. Nucl Med Commun 21:1029–1032CrossRefGoogle Scholar
  16. 16.
    Wanner A (1983) Allergic mucociliary dysfunction. Laryngoscope 93:68–70CrossRefGoogle Scholar
  17. 17.
    Sakakura Y, Ukai K, Majima Y, Murai S, Harada T, Miyoshi Y (1983) Nasal mucociliary clearance under various conditions. Acta Otolaryngol (Stockh) 96:651–654CrossRefGoogle Scholar
  18. 18.
    Di Giuda D, Galli J, Calcagni ML, Corina L, Paludetti G, Ottaviani F, De Rossi G (2000) Rhinoscintigraphy: a simple radioisotope technique to study the mucociliary system. Clin Nucl Med 25:127–130CrossRefGoogle Scholar
  19. 19.
    Morcos MM, Gabr AA, Samuel S, Kamel M, el Baz M, el Beshry M et al (1998) Vitamin-D administration to tuberculous children and its value. Boll Chim Farm 137:157–164Google Scholar
  20. 20.
    Szodoray P, Nakken B, Gaal J, Jonsson R, Szegedi A, Zold E et al (2008) The complex role of Vitamin-D in autoimmune diseases. Scand J Immunol 68:261–269. CrossRefGoogle Scholar
  21. 21.
    Dini C, Bianchi A (2012) The potential role of Vitamin-D for prevention and treatment of tuberculosis and infectious diseases. Ann Ist Super Sanita 48:319–327CrossRefGoogle Scholar
  22. 22.
    Ralph AP (2010) Vitamin-D supplementation in patients with tuberculosis. Am Fam Phys 82:577–583Google Scholar
  23. 23.
    Yim S, Dhawan P, Ragunath C, Christakos S, Diamond G (2007) Induction of cathelicidin in normal and CF bronchial epithelial cells by 1,25-dihydroxy Vitamin-D(3). J Cyst Fibros 6:403–410CrossRefGoogle Scholar
  24. 24.
    Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S et al (2006) Epidemic influenza and Vitamin-D. Epidemiol Infect 134:1129–1140CrossRefGoogle Scholar
  25. 25.
    Cantorna MT, Zhao J, Yang L (2012) Vitamin-D, invariant natural killer Tcells and experimental autoimmune disease. Proc Nutr Soc 71:62–66. CrossRefGoogle Scholar
  26. 26.
    Marom T, Marchisio P, Tamir SO, Torretta S, Gavriel H, Esposito S (2016) Complementary and alternative medicine treatment options for otitis media: a systematic review. Medicine (Baltimore) 95:e2695. CrossRefGoogle Scholar
  27. 27.
    Levi JR, Brody RM, McKee-Cole K, Pribitkin E, O’Reilly R (2013) Complementary and alternative medicine for pediatric otitis media. Int J Pediatr Otorhinolaryngol 77:926–931. CrossRefGoogle Scholar
  28. 28.
    Akcan FA, Dündar Y, Akcan HB, Uluat A, Cebeci D, Sungur MA, Ünlü İ (2018) Clinical role of Vitamin-D in prognosis of otitis media with effusion. Int J Pediatr Otorhinolaryngol 105:1–5. CrossRefGoogle Scholar
  29. 29.
    Dündar Y, Timurkaynak Y, Demirbas E, Birinci M, Akcan F, Ozergin Z, Dursun E (2018) The role of Vitamin-D in patients with otitis media with effusion. J Ear Nose Throat Head Neck Surg 26:33–39. Google Scholar
  30. 30.
    Holick MF (2007) Vitamin-D deficiency. New Engl J Med 19:266–357CrossRefGoogle Scholar
  31. 31.
    Bouillon R, Carmeliet G, Verlinden L (2008) Vitamin-D and human health: lessons from Vitamin-D receptor null mice. Endocr Rev 29:726–776. CrossRefGoogle Scholar
  32. 32.
    Martineau AR, Jollife DA, Hooper RL (2017) Vitamin-D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 356:6583. CrossRefGoogle Scholar
  33. 33.
    Cayir A, Turan MI, Ozkan O, Cayir Y (2014) Vitamin-D levels in children diagnosed with acute otitis media. J Pak Med Assoc 64:1274–1277Google Scholar
  34. 34.
    Hosseini S, Khajavi M, Eftekharian A, Akbari N (2016) Vitamin-D levels in children with otitis media with effusion: a case-control study. Thrita 5:e31977. CrossRefGoogle Scholar
  35. 35.
    Suzuki M, Watanabe T, Mogi G (1999) Clinical, bacteriological, and histological study of adenoids in children. Am J Otolaryngol 20:85–90. CrossRefGoogle Scholar
  36. 36.
    Lundberg JO (2008) Nitric oxide and the paranasal sinuses. Anat Rec (Hoboken) 291:1479–1484. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyDüzce University School of MedicineDüzceTurkey
  2. 2.Department of Otolaryngology–Head and Neck SurgeryWayne State UniversityDetroitUSA
  3. 3.Department of Internal Medicine, Ministry of HealthAtatürk HospitalDüzceTurkey
  4. 4.Department of Otolaryngology, Ministry of HealthBalıkesir HospitalBalıkesirTurkey

Personalised recommendations