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Outcomes of tympanoplasty in children with down syndrome
Saied Ghadersohi1, Jonathan B Ida2, Bharat Bhushan2
1Northwestern University, Feinberg School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Chicago, IL, USA.
Insights
Children with Down syndrome (DS) frequently experience chronic otitis media with effusion and Eustachian tube dysfunction, leading to persistent tympanic membrane perforations. Tympanoplasty offers a successful repair option, though residual hearing loss can occur.
Area of Science:
- Otolaryngology
- Genetics
- Pediatrics
Background:
- Children with Down syndrome (DS) have a high incidence of chronic otitis media with effusion (COME) and Eustachian tube dysfunction (ETD).
- This often leads to recurrent tympanostomy tube (TT) placements and a greater risk of persistent tympanic membrane (TM) perforations requiring surgical repair.
Purpose of the Study:
- To identify risk factors associated with persistent TM perforations in DS patients.
- To evaluate the outcomes of tympanoplasty in this patient population.
Main Methods:
- A retrospective case series analyzed 91 ears in 69 DS patients with TM perforations.
- Patients were either managed non-surgically (Observation Group) or underwent tympanoplasty (Tympanoplasty Group).
- Clinical features, surgical success rates, and hearing outcomes were assessed.
Main Results:
- Tympanoplasty demonstrated significantly higher closure rates (54.8% primary, 70.9% secondary) compared to spontaneous closure (33.0%).
- Persistent COME/ETD was the sole predictor of failed tympanoplasty (OR 27.2).
- While tympanoplasty improved air-bone gaps, residual hearing loss remained common, with many patients requiring hearing aids.
Conclusions:
- History of COME/ETD and multiple prior TT insertions are linked to persistent TM perforations in DS.
- Tympanoplasty is effective for TM perforation repair in DS patients, but careful management of residual hearing loss is necessary.
- Further research may explore long-term hearing outcomes and the impact of interventions.
Introduction:
The prevalence of chronic otitis media with effusion (COME), and Eustachian tube dysfunction (ETD) is high in Down syndrome (DS) patients. This often necessitates multiple tympanostomy tube (TT) placements resulting in a higher rate of persistent tympanic membrane (TM) perforation requiring tympanoplasty for repair.
Objectives:
To assess risk factors for persistent perforation and outcomes of tympanoplasty in DS patients.
Methods:
Retrospective case series of 91 ears in 69 DS patients with TM perforations, who were either observed or underwent tympanoplasty. Clinical features, surgical outcomes, and hearing outcomes were assessed.
Results:
91 ears were evaluated. Sixty perforations were observed, and 31 perforations were repaired. The closure rate was 54.8% for primary surgery, and 70.9% after secondary surgical interventions in the Tympanoplasty Group, compared to 33.0% spontaneous closure rate in the Observation Group (p < 0.001). The only risk factor for failed tympanoplasty repair was persistent COME/ETD (OR 27.2, p = 0.001). In the Observation Group perforations diagnosed at an older age, with >3 TT insertions, and with persistent COME/ETD were less likely to close spontaneously. Patients undergoing tympanoplasty had worse preoperative pure tone averages than those being observed, but significant improvement in air-bone gaps were noted in the Tympanoplasty Group (p = 0.02) post-operatively. Patients were often rehabilitated with hearing aids regardless of intervention (53.3% Observation Group, 48.4% Tympanoplasty Group).
Conclusions:
Persistent TM perforation in children with Down syndrome was associated with a history of COME/ETD, and multiple prior TT insertions. Tympanoplasty was successful for repair in most patients who underwent surgical intervention, but residual hearing loss was common.
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