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Down Syndrome Abstract
of the Month: Jan 2004

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Efficacy of adenoidectomy in the treatment of nasal and middle ear symptoms in children with Down syndrome

Price DL, Orvidas LJ, Weaver AL, Farmer SA
Int J Pediatr Otorhinolaryngol. 2004 Jan;68(1):7-13.

Mayo Medical School, Rochester, MN, USA

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OBJECTIVE: To compare the efficacy of adenoidectomy in children with Down syndrome and control patients. METHODS: Medical records were reviewed for preoperative symptoms, ear complaints, date and reason for adenoidectomy, and postoperative symptoms in 27 children (mean age, 6.0 years; range, 1.6-14.5 years) with Down syndrome and 53 age- and sex-matched controls who had adenoidectomy between January 1978 and September 1997. Long-term follow-up was aided by telephone interviews. Improvement in nasal and middle ear symptoms after adenoidectomy was calculated as the percentage of patients symptom-free postoperatively among those with symptoms preoperatively. RESULTS: After adenoidectomy, more controls than patients with Down syndrome had improvement in symptoms, including nasal obstruction (86.7% versus 50.0%); snoring (73.2% versus 40.9%); mouth breathing (84.1% versus 40.9%); and middle ear disease (68.0% versus 23.1%). Patients with Down syndrome were 7.7 times more likely to have chronic ear drainage after adenoidectomy. CONCLUSIONS: The results of the study suggest that the efficacy of adenoidectomy in children with Down syndrome is significantly less than that in controls and should influence surgical decision making in these children.

My comments:

This is a retrospective study with results being determined from parental response. I wonder how valid the results are of the parents who were recently contacted regarding a surgical procedure more than fifteen years ago. None of the children had an adenoidectomy alone, but it was combined with either a tonsillectomy or placement of eardrum tubes ("P-E tubes") or both. The children with DS who had increased ear draingage were children who had P-E tubes placed.

While the study does show decreased efficacy of the operation as compared to children without DS, there were still significant improvement noted in restless sleep and nasal congestion in children with DS following the surgery.

The paper also looks at the rate of complications of the surgery. The authors report that the control children had more episodes of bleeding after the operation, while the children with DS had more complications of respiratory problems, nausea or vomiting, and poor oral intake following the surgery. No notation of problems with speech following the surgery were made.

For more on adenoidectomies in children with DS, see my essay on obstructive apnea, and the abstract for March 1998.

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