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Down Syndrome Abstract
of the Month: Oct 1999

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Tympanostomy tubes in children with Down syndrome

Iino Y, Imamura Y, Harigai S, Tanaka Y
Int J Pediatr Otorhinolaryngol 1999 Aug 5;49(2):143-9

Department of Otolaryngology, Teikyo University School of Medicine, Tokyo

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OBJECTIVE: Although the insertion of tympanostomy tubes is regarded as an effective treatment for otitis media with effusion in the general population, it remains to be determined whether tympanostomy tube insertion is also effective for otitis media with effusion in children with Down syndrome. The present study was carried out to determine the efficacy of tympanostomy tube insertion in children with Down syndrome.
PATIENTS AND METHODS: We studied 28 children (18 males and ten females) with Down syndrome and 28 age-matched control children who underwent tympanostomy tube insertion and were followed up for more than 2 years, up to 7 years of age or older. The children were followed up every month for 6 months after the operation and every 2 months thereafter. The tympanostomy tubes were not removed unless granulation tissue appeared around the ventilation tubes.
RESULTS: The cure rate for otitis media with effusion was lower in the children with Down syndrome than in the age-matched control children. Sequelae of otitis media with effusion (atelectatic eardrum, permanent perforation of the eardrum and middle ear cholesteatoma) were significantly often encountered in the former group. The children with Down syndrome had more frequent episodes of otorrhea from the tympanostomy tubes than the control children and antibiotic-resistant-bacteria were frequently isolated. Moreover, improvement in hearing acuity after the placement of tympanostomy tubes was not always achieved in children with Down syndrome.
CONCLUSION: The efficacy of the tympanostomy tube insertion for children with Down syndrome was much lower than in control children. We propose that in children with Down syndrome conservative management should be the treatment of first choice and that the insertion of tympanostomy tubes should be indicated only when hearing loss due to middle ear effusion is in a severe degree and when pathological changes of the eardrum, such as adhesion and deep retraction pocket formation, are going to occur.

My comments:

Well, this was disappointing. It's possible that the depression of the immune system seen in DS may be responsible for the more frequent otorrhea (drainage from the ear canal), but I don't have a reason for the increased incidence of side effects of the tubes. One previous study on the subject found no such increase in incidence of side effects.[Strome M. Laryngoscope. 1981 Oct;91(10):1581-94]

I would partly disagree with the authors' conclusions, as I would add that any sign of chronic hearing loss associated with fluid in the middle ear, not just a severe loss, is an indication for drainage of the fluid.
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