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Down Syndrome Abstract
of the Month: March 2003

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Ear, nose and throat disorders in children with Down syndrome

Mitchell RB, Call E, Kelly J
Laryngoscope 2003 Feb;113(2):259-63

Department of Surgery, Univ. of New Mexico Health Sciences Center, Albuquerque, NM, USA

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OBJECTIVE: To document the reasons for which children with Down syndrome were referred to a pediatric otolaryngology practice, the underlying causes for these referrals, and the complications of routine surgical therapy. STUDY DESIGN: The study is a retrospective review of children referred to the Pediatric Otolaryngology Clinic at the University of New Mexico Health Sciences Center (Albuquerque, NM) during a period of 2.5 years. METHODS: Data were collected on 55 parameters related to ethnicity, demographics, diagnosis, surgical therapy, complications, and systemic comorbid conditions. RESULTS: The ethnicity of the study population was predominantly Hispanic or Latino (62%). The majority of children (76%) were referred for upper airway obstruction. Obstructive sleep apnea and laryngomalacia were the most common disorders in these children. An otological disorder was diagnosed in 70% of the children. Complications occurred after 27% of procedures for insertion of pressure equalization (PE) tubes to treat recurrent otitis media. Systemic comorbid conditions were present in 93% of the children, and the most common was gastroesophageal reflux disease. CONCLUSIONS: Obstructive sleep apnea and laryngomalacia were the most common reasons for referral of children with Down syndrome. Routine surgical procedures that required general anesthesia caused complications that are not common in other children. Treatment for systemic comorbid conditions should be considered as a component of therapy for otolaryngological disorders in children with Down syndrome.

My comments:

This is not a random group of children with DS, since they all presented to the ENT with a problem, so you can't judge a lot from these statistics. There was one interesting point, though, which is the reason why I selected this paper: 27% of the children who had tympanostomy ("PE") tubes inserted alone had complications that required an overnight stay in the hospital. The complications were airway obstruction or poor oral intake. I've said it before, and I'll say it again: no ENT surgery in children with DS should ever be considered routine day surgery.
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