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Diagnosis and therapy for airway obstruction in children with Down syndrome
Ron B Mitchell1, Ellen Call, James Kelly
1Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque 87131, USA. rmitchell@salud.unm.edu
Insights
Children with Down syndrome experience upper airway obstruction due to conditions like laryngomalacia and obstructive sleep apnea. Managing comorbidities is key to successful surgical treatment.
Area of Science:
- Pediatric Otolaryngology
- Genetics and Rare Diseases
- Respiratory Medicine
Background:
- Down syndrome is associated with a higher incidence of upper airway obstruction.
- Understanding the specific causes and comorbidities is crucial for effective management.
Purpose of the Study:
- To identify the causes of upper airway obstruction in children with Down syndrome.
- To emphasize the role of associated comorbidities in the presentation and treatment.
Main Methods:
- Retrospective review of 23 pediatric cases with Down syndrome and upper airway obstruction.
- Data collected included referral reasons, demographics, diagnoses, procedures, complications, and comorbidities.
Main Results:
- Laryngomalacia (43%) and obstructive sleep apnea (48%) were the primary diagnoses.
- Gastroesophageal reflux was a common comorbidity (61%).
- Secondary ear, nose, and throat disorders were present in all obstructive sleep apnea cases.
Conclusions:
- Upper airway obstruction in Down syndrome is age-dependent and influenced by comorbidities.
- Integrated management of comorbidities and secondary ENT disorders is essential for surgical success.
Objectives:
To document the causes of upper airway obstruction in a population of children with Down syndrome and to highlight the role of associated comorbidities.
Design And Setting:
Review of 23 cases involving children with Down syndrome who were referred for upper airway obstruction over a 2(1/2)-year period to the Pediatric Otolaryngology Service of the University of New Mexico, Albuquerque.
Methods:
Data on the following variables were obtained: reason for referral, demographics, diagnosis, surgical procedures, complications, and comorbidities.
Results:
The children ranged in age from 1 day to 10.2 years (mean age, 1.8 years; median age, 6 months). Thirteen children were male and 10 were female. None of the children had subglottic stenosis. Laryngomalacia was the primary diagnosis in 10 children (43%), 8 of whom were younger than 1 month. Obstructive sleep apnea was the primary diagnosis in 11 children (48%), 8 of whom were older than 2 years. All children with obstructive sleep apnea and 4 children with laryngomalacia had a secondary ear, nose, and throat disorder. Gastroesophageal reflux was a comorbidity in 14 children (61%).
Conclusions:
The causes, severity, and presentation of upper airway obstruction in children with Down syndrome are related to the age of the child and to associated comorbidities. The treatment of comorbidities and secondary ear, nose, and throat disorders is an integral component of the surgical management of upper airway obstruction in such cases.