Professional Corner
Hearing Loss in Down Syndrome
Linked to Otitis Media
The identification of secretory otitis media in children with Down
Syndrome is important in maximizing the educational potential of this
population, researchers report this week, because the problem may
lead to hearing loss and further compromise the child’s language
development and social interaction.
Children with Down Syndrome may not provide the needed feedback to
parents regarding their middle ear disorders or hearing impairment.
Therefore, parents should be vigilant in noting symptoms and seek
care where appropriate.
A team of otolaryngologists and specialists examined the incidence
of middle ear infections and associated behavior among young patients
with Down Syndrome. Previous literature states that hearing impairment
is frequent in this population. Conductive hearing loss is responsible
for most of these cases, which have been widely attributed to the
high incidence of secretory otitis media. The craniofacial dysfunction
characteristic of the syndrome seems to predispose this disorder,
which presents hearing loss as the only symptom.
A questionnaire was provided to the custodial guardian for 30 male
and 21 female patients with Down Syndrome to identify middle ear disorders.
The ages ranged from 7 months to 17 years, with an average of 3 years,
7 months. Each subject underwent a complete physical examination.
To avoid subjective analysis and comparison, the exams and tympanograms
were performed by the same physician and audiologist.
The criteria used to evaluate middle ear disorders were instance
of hearing loss related by parents, past history of otitis media,
an otoscopy examination to classify ears as normal or altered, and
a tympanometry to define types of tympanograms in each ear. A clinical
assessment was made to ascertain external auditory ear stenosis. Upper
airway obstruction was suspected when mouth breathing, snoring, drooling,
and obstructive sleep apnea was observed. The patients then were subdivided
into two groups – those with and those without an obstruction.
The parents of 10 children (19.6 percent) believed that their child
had a hearing loss. After the initial examination middle ear disorders
were observed in 17 patients (33.3 percent). Of that group, secretory
otitis media was noted in 16, and cholesteatoma in one. Fourteen of
the 17 (82.3 percent) showed an abnormal Eustachian tube function
associated with upper airway obstruction.
Follow-up was conducted on 40 of the 51 subjects over a minimum period
of 10 months. Of those, chronic secretory otitis media was observed
in 27, while seven did not present with any symptoms. Of the 27 patients
with chronic otitis media, 22 (81.5 percent) presented with upper
airway obstruction.
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