Why I Test for Micronutrients: The ENT Connection (Part 1)

As an integrative ENT, I see every day how small deficiencies can have big effects on everyday ENT health. When patients come in with chronic sinus infections, poor sleep, or slow healing after surgery, I look below the surface. One of the most powerful tools in my diagnostic approach is micronutrient testing.

Micronutrients-vitamins and minerals-are the quiet workhorses of your immune and nervous systems. When levels dip, the first clues often show up in subtle ENT symptoms: recurrent sore throats, poor mucus clearance, dizziness, or tinnitus. Understanding your nutrient status can uncover a missing piece of the puzzle and help restore true immune resilience. Let’s cover some of the top ones I routinely evaluate in my clinic.

Vitamin D: The Immune System’s Thermostat

Vitamin D isn’t just about bone health-it’s one of the most important regulators of your innate and adaptive immunity. Low vitamin D levels are linked to increased rates of upper respiratory infections, chronic rhinosinusitis, and ear infections. This nutrient helps the immune system respond efficiently, calming inflammation while keeping defenses strong.

In my adults patients, optimizing vitamin D often reduces the frequency and severity of sinus flares and improves allergy symptoms. Because vitamin D acts more like a hormone than a simple vitamin, keeping your level in the functional range of 50–80 ng/mL (rather than the “bare minimum” 30 ng/mL) can make a noticeable difference in your immune balance.

It’s important for kids too though. Vitamin D deficiency is linked to higher rates of viral respiratory illnesses, ear infections and food allergies.

Typical dosing:

• Adults: 1,000–2,000 IU daily for maintenance; 4,000 IU/day (or physician-guided repletion) if levels are very low.

• Children: 400–1,000 IU/day depending on age and baseline level.

• Always re-test after 8–12 weeks and adjust seasonally.
  Preferred forms: Vitamin D3 (cholecalciferol) with K2 (MK-7) for better calcium balance.
  Natural sources: Wild salmon, sardines, egg yolks, fortified plant milks, mushrooms, exposure to sunlight.

Iron: Oxygen Delivery and Mucosal Healing

Iron’s role extends far beyond energy and anemia, it’s essential for oxygen delivery to every tissue, including the delicate linings of the nose, throat, and inner ear. Low iron can manifest as fatigue, dizziness, restless legs, or slow wound healing, all of which impact ENT health. It also impairs mucosal immunity, making the sinuses and throat more vulnerable to infection.

I frequently test ferritin (your iron storage marker) with a full iron panel in patients with chronic inflammation or heavy menstrual cycles. For most women, optimal ferritin is between 50–100 ng/mL and 70–120 ng/mL for men. Below 30, mucosal healing slows and fatigue worsens-even if the lab calls it “normal.”

Typical dosing:

• Adults: 25–65 mg elemental iron daily (commonly every other day to improve absorption).

• Children: 3 mg/kg/day of elemental iron divided in two doses.

• Always re-evaluate ferritin and iron saturation after 8–12 weeks before continuing supplementation.
  Preferred forms: Iron bisglycinate or heme iron polypeptide (gentler on the stomach).
  Natural sources: Grass-fed beef, liver, shellfish, lentils, spinach, pumpkin seeds, and vitamin C-rich foods to enhance absorption.

Vitamin B12: Nerve Health and Recovery

Vitamin B12 supports the health of every nerve in the body, including those that regulate hearing, balance, and swallowing. Low B12 levels are linked to tinnitus, dizziness, burning mouth syndrome, and neuropathic throat pain. It also plays a role in detoxification and neurotransmitter production that affect focus and mood.

For true functional health, I aim for B12 levels of 500–900 pg/mL, especially in patients on plant-based diets or acid-suppressing medications, which can impact absorption of B12 from nutritional sources.

In some individuals-especially those with neurological symptoms, fatigue, or borderline B12 levels-methylmalonic acid can reveal “functional” deficiency even when serum B12 appears normal, since it rises when cellular B12 is insufficient. Similarly, homocysteine can help assess methylation and folate-B12 balance, offering a broader view of cardiovascular and neurologic health. Together, these tests give a more complete picture of how nutrients are actually working inside the body, not just how much is circulating in the bloodstream.

Typical dosing:

• Adults: 500–1,000 mcg daily (oral or sublingual). Injectable B12 may be used in malabsorption or severe neurologic symptoms.

• Children: 5–10 mcg/day for maintenance; higher if deficiency confirmed.
  Preferred forms: Methylcobalamin or adenosylcobalamin (active forms); avoid cyanocobalamin when possible.
  Natural sources: Fish, poultry, eggs, dairy, and fortified nutritional yeast for vegetarians.

What to Ask For: Lab Tests and Ideal Ranges

When requesting nutrient testing, ask your provider for:

• 25-hydroxy vitamin D (25-OH D) → ideal: 50–80 ng/mL

• Ferritin (iron storage) → ideal: 50–100 ng/mL (women), 70–120 ng/mL (men)

• Vitamin B12 and → B12 ideally 500–900 pg/mL

• Methylmalonic Acid (MMA) and Homocysteine (optional) → MMA in low-normal range, homocysteine 5–8 µmol/L for optimal methylation

These functional ranges reflect where most people feel and heal best, not just where disease is prevented.

Integrating Nutrient Insight into ENT Care

I love supporting my patients in correcting deficiencies through food first, using nutrient-dense meals that fit their lifestyle and preferences. Food provides the full spectrum of cofactors and phytonutrients that supplements can’t replicate. However, when levels are significantly low-or when absorption issues, inflammation, or medical conditions are present-targeted supplementation becomes a bridge to restore balance and resilience more quickly and safely.

Because your sinuses, ears, and throat don’t exist in isolation—they’re reflections of your overall vitality.

*Stay tuned for part 2 later this month!

Disclaimer: This information is for educational purposes only and not a substitute for medical advice. Always consult your healthcare provider before starting or changing supplements.