Peggy E Kelly - Ear, Nose and Throat Issues in Children With Down Syndrome - English

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Ear,NoseandThroatIssuesin

ChildrenwithDownSyndromePeggyE.KelleyMDFACSFAAP

AssociateProfessorofOtolaryngology

UniversityofColorado,DenverChildrensHospitalColorado

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Goals

ReviewnormalanatomyandtypicalproblemswiththeEar,NoseandThroat.

ShowhowchildrenwithDownSyndromehaveanatomicdifferencesthatinfluencetheir

diseaseprocessesandtreatments.

HaveanideahowanENT(Ear,Nose,andThroatdoctororOtolaryngologist)canhelp

careforyourchild.

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Ear

Hearing 3parts

Outer Middle Inner

Testwith: Tympanometry Oto-AcouscEmission

Audiometry Balance

3semicircularcanals Affectedbypressurein

themiddleear

Conducve

Sensorineural

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Ear

Outerear Wax

Buildup Treatwithweeklyoil

Infecon Swimmersear

Treatwithvinegar/alcohol

ForeignBody Sponge,beads,etc

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ChildwithDownSyndrome

OuterEar-Canal Cerumen(wax)buildup

Hourglassshape

Flakytypewax Oilweekly Havecleanedbyhealth

careprovider

MiddleEar InnerEar

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Ear

OuterEar-Canal MiddleEar

Fluid/Infecon ConducveHearingLoss

Donthearaswellunderwater

ClearthroughEustaciantube(ETTube)

InnerEar

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ChildwithDownSyndrome

OuterEar-Canal MiddleEar

Fluid/Infecon

Immunesystemissues ConducveHearingLoss

80%ofhearingproblems Clearthrough

Eustaciantube(ETTube) Skullbaseshapefla^er

meansdoesnotclearaswell

InnerEar

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Ear

OuterEar-Canal MiddleEar InnerEar

Sensorineural/NerveHearingLoss

Congenal(bornwith) Newbornscreen

Acquired(developslater) Rounehearingchecks

Balance

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ChildwithDownSyndrome

OuterEar-Canal MiddleEar InnerEar80%have

someproblemwithhearing

Sensorineural/NerveHearingLoss

Congenital(bornwith) Newbornscreen

Acquired(developslater) Rounehearingchecks

BalanceAnd/OR

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Tonsils

Sizema^ers Tonguesizeand

posionma^ers

Canremovetonsils Lesseasilyoperateon

baseoftongue

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ChildwithDownSyndrome

Breathe Lessroom

Warm Filter Humidify

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Oralcavitycomparison

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Speech

Soundgenerator larynx/voiceboxLungsforpowerCryorlaugh

LanguageintelligibilityResonance

SkullbaseshapeandPalateshapeandmovementArculaon

Lips,tongue,palate Controlofmovement-apraxia

Voluntaryprogramming,combining,organising,andsequencing

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ObstrucveSleepApnea

ChildwithoutDownSyndrome

Symptoms: Snoring/Apnea Restlesssleep Behaviorissuesbecausered Bedweng Difficultyeangsolidfood Schoolperformanceissues

ChildwithDownSyndrome

Symptoms Mayhavenosnoring Mayornotberestless Behaviorissuesmaybe

independentofrest

Eangissuesmaybefromlargetonsilsorother

neurologic/coordinaonissues

Schoolperformancemaybesecondarytootherdelays

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ObstrucveSleepApnea

ChildwithoutDownSyndrome

Diagnosis: Sleepstudyformismatch Oendonotneedtorepeataertreatmentbecause

symptomsgone

ChildwithDownSyndrome

Diagnosis: Screeningsleepstudyevenif

notsymptomac Repeattobesuretreatment

helpednospecificsymptom

tofollow

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ObstrucveSleepApnea

ChildwithoutDownSyndrome

Treatment: Tonsillectomyand

adenoidectomy Nasalturbinatereducon+/-

Growthtypicallyenlargesairwaywithskullbaseflexion

ChildwithDownSyndrome

Treatment Oxygentherapy Posivepressuremask(CPAP) Tonsillectomyand

adenoidectomy

Nasalturbinatereducon+/- Growthmayworsenairway

becauseskullbasedoesnotchange

Oxygentherapy/CPAP Non-invasive

Sleependoscopytofindsiteofobstrucon

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SleepEndoscopy

Goals

Findsiteofanatomicblocking

Findsiteofdynamicblocking

Usesarficialsleep Researchonbestwayto

replicaterealsleep

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ObstrucveSleepApnea

ChildwithDownSyndrome

Treatment Tonguebasereducon/

advancement

Hyoidadvancement Pharyngoplasty

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Conclusion

ChildrenwithDownSyndromehavereasonsbothanatomic(structural)andphysiologic

(funconal)tohave:

Hearingloss,NasalobstruconBreathingproblems/sleepapneaSpeakingandlanguagechallenges

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Conclusions

KnowingwhyapersonwithDownSyndromehasENTissuescanhelpthefamilyunderstand

whyusualtreatmentsmayormaynotwork.

Knowingwhycanhelpexplainwhywesomemesneedtodomore.

Gengtoknow(andLove)yourENTcanbeagreatthing!

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References

(Sho^,S.R.(2000).Downsyndrome:Commonpediatricear,noseandthroatproblems.DownSyndromeQuarterly,5(2),1-6.)

Balkany,T.J.,Mischke,R.E.,Downs,M.P.&Jafek,B.W.(1979).OssicularabnormaliesinDown'ssyndrome.Otolaryngology:HeadandNeckSurgery,87,

372-384.

Sho9S,etalObstrucveSleepApnea:ShouldAllChildrenWithDownSyndromebeTested?ArchOtolaryngolHeadNeckSurg.2006;132:432-436