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ask the expert I have noticed that much of the exciting human research on vitamin D originates in Turkey and Iran. I don't know why, but researchers in those two countries keep publishing exciting clinical trials. Take ear infections or acute otitis media. It is the most common infection that requires medical attention during childhood. AOM is the presence of fuid in the middle ear with acute signs of illness and middle ear infammation such as bulging, cloudiness or redness of the eardrum. AOM is more common in the winter. It is unknown if it is more or less common based on latitude. When I was a general practitioner, it was common practice to put all children with AOM on antibiotics. Now, the concern about antibiotic resistance has changed that practice. Research shows that over 80 percent of ear infections resolve without antibiotics. That means, for example, that about 33 children must be treated with antibiotics to prevent one ruptured eardrum. Also, for every 14 children treated with antibiotics, one child has side effects to the antibiotic, such as vomiting, diarrhea or a rash. So it is now recommended to wait a few days before starting antibiotics and simply treat the ear pain. In yet another exciting Turkish study, Dr. Atilla Cayir, working under the supervision of senior author Professor Behzat Ozkan at Ataturk University, published an open trial of vitamin D in 84 children with recurrent otitis media. They studied 79 children, all of whom had either four or more attacks of AOM in one year, or three or more attacks in six months. Mean initial serum 25(OH)D levels in the study group were about 11 ng/mL, and levels under 20 ng/mL were seen in 69 percent of the children, who were between ages one and fve. Patients with low initial serum vitamin D levels (<15 ng/mL) were administered 5,000 IU/day, but neither the authors nor the paper's editor clarifed for how long. However, at the end of the one-year study, mean vitamin D levels were only 23 ng/ml, meaning the 5,000 IU/day was only given for only a short time. All children were treated with antibiotics if needed, so standard treatment was used, not just vitamin D. In the one-year of followup of the 79 patients with recurrent otitis media, only one attack of AOM was detected in fve patients, and two attacks in two patients. Despite having had recurrent otitis media, no ear infections were observed in any of the remaining 72 patients over the year. The authors concluded: "These results support the view that vitamin D is a major immune-modulator and that defciency may increase the incidence of upper respiratory infections such as otitis media. We believe that co-administration of supplementary vitamin D together with conventional treatments is appropriate in the management of upper respiratory infections such as recurrent otitis media." So, besides just waiting and treating the pain, practitioners now have precedent to give children with AOM vitamin D while they are waiting. Cayir A, Turan MI, Ozkan O, Cayir Y, Kaya A, Davutoglu S, Ozkan B. Serum vitamin D levels in children with recurrent otitis media. Eur Arch Otorhinolaryngol. 2013 Mar 30. Dr. John Cannell is founder of the Vitamin D Council. He has written many peer-reviewed papers on vitamin D and speaks frequently across the United States on the subject. Dr. Cannell holds an M.D. and has served the medical feld as a general practitioner, itinerant emergency physician, and psychiatrist. 69 SMART TAN MAGAZINE ❘ SmartTan.com