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Repeat tympanostomy tubes in children with Down syndrome
Mahmoud Omar1, Jennifer L McCoy2, Andrew A McCormick3
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Insights
Children with Down syndrome (DS) undergoing tympanostomy tube insertion (TTI) have a high repeat rate of 61.4%. Younger age and chronic otitis media with effusion increase the likelihood of repeat TTI in DS patients.
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Genetics
Background:
- Children with Down syndrome (DS) exhibit a higher prevalence of tympanostomy tube insertion (TTI) compared to the general pediatric population.
- Limited research exists on factors influencing multiple TTIs in children with DS.
Purpose of the Study:
- To identify factors associated with an increased or decreased likelihood of repeat tympanostomy tube insertion (TTI) in children with Down syndrome (DS).
Main Methods:
- A retrospective case-control study analyzed data from 277 children with DS who underwent their first TTI between 2007 and 2018.
- Follow-up duration was at least 27 months post-initial TTI.
Main Results:
- The repeat TTI rate was 61.4%.
- Chronic otitis media with effusion (COME) at first TTI was a significant risk factor for repeat TTI (OR: 2.01).
- Younger age at first TTI was associated with a higher rate of repeat TTI (OR: 0.84).
Conclusions:
- Children with DS are more prone to repeat TTIs, particularly if younger and diagnosed with COME.
- The high repeat TTI rate underscores the need for further investigation in this population.
- Prospective studies are recommended to refine understanding of repeat TTI factors in children with DS.
Objectives:
Children with Down syndrome (DS) have a higher incidence of tympanostomy tube insertion (TTI) than children in the general population. As there were no studies investigating factors that are associated with multiple TTIs in children with DS, we sought to determine what factors increase or decrease the likelihood of repeat TTI in children with DS.
Methods:
A retrospective case-control study was performed on consecutive children with DS from 2007 to 2018 with first TTI at a large tertiary children's hospital and follow-up duration at least 27 months since first TTI.
Results:
277 patients met the inclusion criteria. Repeat TTI rate was 61.4%. Having an indication of chronic otitis media with effusion (COME) at first TTI was an adjusted risk factor for increased rate of repeat TTI (OR: 2.01, 95%CI: 1.15-3.51, p = .014), while being older at first TTI was an adjusted protective factor for decreased rate of repeat TTI (OR: 0.84, 95%CI: 0.74-0.95, p = .004). Adenotonsillectomy at or before first TTI was not an adjusted protective factor for decreased rate of repeat TTI (OR: 0.915, 95%CI: 0.448-1.872, p = .809) and bilateral intra-operative fluid was not an adjusted risk factor for repeat TTI (OR: 1.97, 95%CI: 0.99-3.90, p = .054).
Conclusion:
Children with DS were more likely to undergo repeat TTI if they were of younger age and if the indication for surgery was COME. The repeat TTI rate for children with DS was high at 61.4%. Prospective studies are warranted to more precisely investigate factors associated with repeat TTIs in this unique patient population.
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