الفهرس 
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Abstract
Chronic suppurative otitis media (CSOM) is a chronic inflammation (lasting more than three months). of the middle ear or mastoid cavity, characterized by ear discharge (otorrhoea) through a perforated tympanic membrane. The main symptoms of CSOM, which is typically caused by gram-negative bacteria, include hearing loss and ear drainage.
The prevalence of CSOM is influenced by factors such as age, low socioeconomic status, substandard housing, overcrowding, and insufficient access to medical care.. Tubotympanic and atticoantral diseases are the two main categories for CSOM.
The primary cause of CSOM is bacterial and viral infections in the upper airway and middle ear. However, a number of predisposing conditions, such as immune system problems and Eustachian tube dysfunction, might lead to the development of CSOM.
The diagnosis of chronic suppurative otitis media (CSOM) is based on history taking and otoscopic examination which include centeral Perforation.
Our study was done on patient diagnosed with CSOM and control group on vitamin D level in two group to discover if there relation between vitamin D level and the occurance of CSOM.
All immune system cells, notably those in the B and T cells, monocytes and macrophages have receptors for vitamin D.
Vitamin D is extremely beneficial to the immune system, especially when the body is switching from innate to acquired immunity.cytokines which cause inflammation Leucocyte chemotaxis is disrupted, vitamin D insufficiency is increasing, the immune system is weakened, and there is a susceptibility for infection. As a result, vitamin D deficiency has been cited as a risk factor for infection. Vitamin D increases the conversion of immature monocyte to mature macrophage.Our study was conducted on 85 children aged from 3 to 16 years old at Otorhinolaryngology department, Minia University Hospital from February 2022 to October 2022. after receiving permission from the institution’s ethics committee and agreement from all of the parents of all children.
Children divided into 2 groups: group A (case group) Forty-five cases with chronic suppurative otitis media (CSOM) either unilateral or bilateral with history of recurrent ear discharge more than 3 months duration, otoscopic examination reveals central tympanic membrane perforation, and group B (control group) including Forty healthy children with normal tympanic membrane (TM). The concentration of 25(OH)vitamin D was measured in serum samples.
Eighty-five children, divided into forty-five cases suffering from CSOM (15 males and 30 females) either unilateral CSOM in 33 cases (73.3%) or bilateral CSOM in 12 cases (26.7%) (Case group) and forty children (20 males and 20 females) with normal tympanic membrane (Control group). The mean vitamin D level in case group was 27.4 ± 22.1 while in control group was 35.6 ± 15.9.
In case group Vitamin D deficiency was detected in 24 cases (53.3%), insufficient in 5 cases (11.1%), and sufficient in 16 cases (35.6%) while in control group, Vitamin D deficiency was detected in 5 cases only (12.5%), insufficient in 10 cases (25%), and sufficient in 25 cases (62.5%) with a significant variation in vitamin D insufficiency between the and control and case groups.
Our study showed that Vitamin D level in children with CSOM was found to be significantly lower than that in control group with normal TM, so assessment of vitamin D level is very important in children with CSOM to decrease recurrent acute exacerbation and prevent complications.