Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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Home / A–Z Services / Pediatric Surgery / Ear, Nose and Throat (ENT) Otolaryngology / Your ENT Visit / Ear, Nose and Throat Problems with Down Syndrome
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Ear, Nose and Throat Problems with Down Syndrome


Children with Trisomy 21 (Down Syndrome) tend to experience a number of otolaryngologic (ear, nose and throat) conditions that we will need to follow closely.

In 40 to 50 percent of children the ear canals are stenotic (very narrow). This can make for difficult examination of the ear drum and middle ear space. It also results in cerumen (wax) accumulations. We will need to monitor these children at least every three months until the ear canals have grown to ensure that no middle ear disease is present and an optimal hearing environment exists for the child.

Eustachian tube dysfunction is common, with risk of recurrent acute otitis media (ear infection) and/or chronic otitis media with effusion (persistent ear fluid). The need for tympanostomy tubes is extremely common in this population.

Hearing loss is common, the vast majority from difficulties with conducting sound (often helped with tympanostomy tubes). Four to 20 percent of these children may also have a mixed or sensorineural loss (hearing loss related to the brain process of sensation). Hearing testing will be performed routinely on such children to identify any hearing loss.

Speech disorders, such as speech delay, are common. The voice may be gruff or harsh. Speech evaluation and therapy may be needed.

Obstructive sleep and disordered breathing are very common in these children. Some reports indicate that 100 percent of children with Down syndrome have sleep apnea. Often the tonsils and/or adenoids are a large culprit, and removal of this tissue with adenotonsillectomy is frequently necessary. Unfortunately, a low underlying tone of pharyngeal muscles, relatively large tongue, low skull base position, and large body can also contribute, necessitating other procedures and possibly CPAP (continuous positive airway pressure therapy) after the adenotonsillectomy.

These children's airways can be narrower than usual, or tracheal anomalies can lead to respiratory distress. Laryngomalacia (floppy voicebox) is common in infancy.

Chronic rhinitis and sinusitis are frequently seen in these children. This is related to narrow nasal passages, low skull bases, poorly developed sinuses, and possible allergic or immune factors. It is critical to maintain nasal hygiene with nasal saline sprays. An aerosol spray in a can such as Simply Saline, Nasamist, or Ocean Mist can be used five or more times a day, and with an even higher frequency if the child is developing an upper respiratory infection.

Finally, these children are at an elevated risk when undergoing anesthesia, and should only undergo surgery at a place where Pediatric Anesthesiologists are available who are well attuned to the perioperative issues of children with Down. They may need specialized x-rays of the neck ("flexion/extension") prior to undergoing surgery.

Last Edited: July 6, 2016
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