Down Syndrome Abstract
of the Month: Dec 2001
Hearing loss in children with Down syndrome
Shott SR, Joseph A, Heithaus D
Int J Pediatr Otorhinolaryngol 1;61(3):199-205, 2001
Dept of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, OH, USA
Abstract:
Objective: Previous studies report a 38-78% incidence of hearing loss in children with Down syndrome (DS). The purpose of this study was to establish more up to date information about hearing loss in children with DS. Methods: A 5-year longitudinal study following the otolaryngologic problems seen in children with DS was initiated in February, 1999 at the Children's Hospital Medical Center in Cincinnati, OH. Aggressive, 'state of the art' treatment, both medical and surgical, was provided to a group of children, (n=48), all of whom were entered into the study at an age under 2 years. Specific interventions and treatments were reviewed in regards to following and treating the children's chronic ear disease. Hearing level results at the end of the first year of the study were evaluated in this publication. This includes both pre-treatment and post-treatment audiologic results. Results: After treatment of easily reversible hearing loss from chronic otitis media, either with medical or surgical treatment with PETs (Pressure Equalization Tubes), 98% of the children had normal hearing levels. Only two children had residual mild hearing losses after treatment interventions. Conclusion: Aggressive, meticulous and compulsive diagnosis and treatment of chronic ear disease in children with DS, started soon after birth, provides significantly improved hearing levels than reported previously.
My comments:
More details: each child was seen every 6 months by the ENT staff. If the children had extremely small ear canals, they were seen every 3 months. Each visit included cleaning out wax and visualization of the eardrum. If the child's regular doctor diagnosed and treated a middle ear infection, the child was seen by the ENT staff for follow-up examination. ABR (auditory brain response) exams were done before the child was entered into the study and ABRs or behavioral hearing tests were done periodically thereafter.
40 of the 48 children in the study required PET's (ear tubes) due to chronic otitis media. Of these 40 children, 18 required only one set; the other 22 required two or more sets. The most common age of placement of tubes was between 6 and 18 months of age.
Why do infants with DS have such a high incidence of chronic otits media? The authors state that the main reason is malfunction of the eustachian tube, the tube that leads from the middle ear to the back of the mouth. This then leads to the accumulation of fluid in the middle ear.
The main purpose of this study is to refute the arguments made in a 1999 study on ear tubes and children with DS that I reviewed previously. The 1999 study indicated that PETs made no impact on hearing. The current study shows the opposite, however the 1999 study concentrated on older children with DS and this study looked at infants.
So the bottom line is that early and aggressive use of PE tubes to prevent chronic otitis media appears to prevent the hearing loss for which children with DS are at high risk.