Release: Embargoed until September 26
Contact: Ken Satterfield
(in New Orleans: 9/23-29 at 504-670-5409)
[email protected]
THE HIGH RATE OF CONDUCTIVE HEARING LOSS AT AN EARLY AGE AMONG DOWN'S SYNDROME PATIENTS CAN BE ATTRIBUTED TO CHRONIC MIDDLE EAR DISORDERS
Conclusions of a new study call for parents to be vigilant in observing symptoms of hearing loss and ear discomfort in children with Down's syndrome
New Orleans -- The incidence of Down's syndrome (DS) is estimated in 1.5 in every 1,000 live births or 7,000 newborn children annually in the United States. They account for ten percent of all mentally retarded people.
Previous literature states that hearing impairment is frequent among Down's syndrome patients. Conductive hearing loss is responsible for most of the cases of hearing impairment which has been widely attributed to the high incidence of secretory otitis media (inflammation of middle ear mucosa, often accompanied by accumulation of fluid, secondary to eustachian tube obstruction). The craniofacial dysfunction characteristic of the syndrome seems to predispose this disorder which presents hearing loss as the only sympton.
A team of otolaryngologist--head and neck surgeons and specialists with Down's syndrome patients examined the incidence of middle ear infections and associated behavior among young DS patients. The authors of the research study, "Middle Ear Disorders in Down's Syndrome," are Daniela Curti Thome, MD, and Tanit Ganz Sanchez, MD, Ricardo Ferreira Bento, PhD, and Maria Elisabete Bovino Pedalini, all from the University of Sao Paulo Medical School; and Elisa Maria Moreira Carcez, MD, and Mara Sarruf, both from the Association of Parents and Friends for Mentally Handicapped of San Paulo.
The results were presented before the American Academy of Otolaryngology--Head and Neck Surgery Foundation Annual Meeting and Oto Expo being held September 26-29, at the Ernest N. Morial Convention Center in New Orleans, LA. At the gathering, the Academy's 11,000 members will have the opportunity to hear the latest research in the diagnosis and treatment of disorders of the ear, nose, throat, and related structures of the head and neck.
Methodology.
A questionnaire was provided to the custodial guardian for 30 male and 21 female patients with Down's syndrome to identify middle ear disorders. The ages ranged from seven months to 17 years with an average of three years, seven months. A complete physical examination was performed on each subject; 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 (1) instance of hearing loss related by parents; (2) past history of otitis media; (3) an otoscopy examination to classify ears as normal or altered; (4) a tympanometry to define types of tympanograms in each ear. A clinical assessment was made to ascertain external auditory ear stenosis. Upper airway obstruction (UAO) was suspected when mouth breathing, snoring, drooling, and obstructive sleep apnea was observed. The patients were then subdivided in two groups: those with and without UAO.
Results: Key findings of the study were:
* The parents of ten patients (19.6 percent) believed their child was suffering from 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, 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 ten months. Of the 40, chronic secretory otitis media was observed in 27; seven did not present any symptoms during the follow-up period. Of the 27 patients with chronic secretory otitis media, 22 (81.5 percent) presented associated upper airway obstruction.
Conclusion.
The authors emphasize that the identification of secretory otitis media in children with Down's syndrome is important in maximizing the educational potential of this population. This is because the problem may lead to hearing loss and further compromise the child`s language development and social interaction. Children with Down's syndrome may not provide the needed feedback to parents regarding their middle ear disorders or hearing impairment -- accordingly, parents of these special needs children should be vigilant in noting symptoms of this disorder and seek care when appropriate.
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Editor's Note: For a copy of this study or an interview with Dr. Thome, contact Ken Satterfield at 703-519-1563 (through 9-21); 9/23-29, call the Annual Meeting Newsroom at 504-670-5409.
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