• Down Patients predisposed – Small canals – Normal movement of wax inhibited – Developmental issues • Foreign bodies
Middle Ear: Acute Otitis Media • Increased URIs – Decreased T and B cell fuction?
• Midface hypoplasia – Small ET openings – Relative adenoidal hypertrophy
• Eustachian tube – Small – Collapsed – Hypotonia
Middle Ear: Chronic Effusions • Same underlying problems as AOM • Longer term hearing deficit • Over long periods can lead to more significant problems – Cholesteatoma – Ossicular dissolution
Result: Hearing Deficit, or Loss • 50 to 90% of randomly selected children showed hearing impariment. • Conductive • Sensorineural • Mixed
Down Syndrome: Hearing loss • Sensorinerual – As a result of recurrent infection • Bony deposition in – Internal Auditory Canal – Spiral tract
– Congenital • Small structures have been noted – All structures have been noted to be abnormal
Down Syndrome: Hearing Loss • Conductive – Deficit not loss
• Fluid – TM cannot vibrate
• Ossicular chain discontinuity • Cholesteatoma • Mastoid hypo aeration – Cause or effect
Down Syndrome: Hearing Loss • Effect – Language development – Cognitive development
Down Syndrome Ears:
• Higher risk for infection • Higher risk for effusion • Higher risk for hearing problems
Goals of Intervention • Defend hearing • Avoid complicated surgery • Predicated on – Accurate assessment • Ear canal • Middle ear • Hearing
– Early intervention • Tympanosotomy tubes • Hearing aids
Intervention: Physical Exam • • • •
Small ear canals make this difficult Must be able to assess middle ear status Clear canals a must prior to audiogram May require – Microscope – Evaulation under anesthesia
Intervention: Hearing Assessment • At birth – Screening ABR – Full ABR
• Every 6 months until age 3 – Catch problems earlier
• Yearly above age 3 – Improving anatomy and physiology • Ears are better able to stay healthy
Intervention: Tympanostomy Tubes • Alternate aeration pathway • Buy time for child to grow • Short procedure
Tympanostomy Tubes: Yes or No • Some studies show less of a positive effect – Hearing (60 vs 90%)
• Recurrent effusion after extrusion – Due to DS not tube failure
• Related to later intervention?
Tympanostomy Tubes: Yes!! • “Complications” noted in studies – Likely related to lack of early intervention\ – All are signs of long standing ear disease
• Prevent complications • Always only in appropriate cases
Tympanostomy Tubes: Yes!! • Early intervention leads to better hearing – Cincinnati study, Shott • 93% of kids had normal hearing • 3.6 times more likely to have normal hearing
– Early intervention, Whiteman • As adolescents, better language skills
• Always only in the appropriate patients
Down Syndrome: Ear Problems • Hearing deficits common • Due to multiple factors – Sensorineural factors • Unpreventable • Find and treat early
– Conductive factors • Higher risk of ear infections, fluid • Small canals lead to difficult exam
• Exam and hearing test early and often • Early intervention may prevent much trouble
