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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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Last modified: January 26, 2013