Otitis Media with Effusion in Down’s Syndrome: Outcome Following Ventilation Tube Insertion

Research Article

Austin J Otolaryngol. 2016; 3(3): 1078.

Otitis Media with Effusion in Down’s Syndrome: Outcome Following Ventilation Tube Insertion

Rajagopal R*, Rizal FE, Prescott C and Hamid Daya

Oxford Deanery ENT Trainee, St George’s Hospital, London

*Corresponding author: Rajini Rajagopal, Oxford Deanery ENT Trainee, 111-113 Hampstead Rd, NW1 3EE, London

Received: July 19, 2016; Accepted: September 14, 2016; Published: September 16, 2016


Objective: NICE guidelines recommend that hearing aids should normally be offered to children with Down’s syndrome and Otitis Media with Effusion (OME) with hearing loss. We looked at our experience in the light of the NICE guidelines and assessed parental satisfaction with grommet insertion.

Patients and Methods: We studied 75 children with Down syndrome referred to a tertiery ENT & audiology service centre for OME with hearing loss in 2005 & 2006, re-visited in 2011 & 2012. This was a retrospective case study review, outpatients and telephone questionairre.

Results: OME with hearing loss was diagnosed in 61 patients. 85% of these patients had grommets inserted. The average age of insertion was 5 yrs with a range of 1-11yrs. 47 patients had hearing aids fitted prior to insertion of grommets and 13 patients continued to use hearing aids due to a mixed hearing loss.

Conclusion: Our study has shown that parents prefer to undergo grommet insertion rather than have hearing aids. The technical difficulties with grommet insertion in children with Down’s syndrome were overcome by taking some specific steps during surgery and complications were less than anticipated.

Keywords: Down’s syndrome; Ventilation; Otitis media; Hearing aids


In 1866, down described clinical characteristics of the syndrome that now bears his name. In 1959, Lejeune and Jacobs et al independently determined that trisomy 21 is the cause. Down Syndrome (DS) is by far the most common and best known chromosomal disorder in humans and the most common cause of intellectual disability [1].

The DS patient has clear anatomic differences in the head and neck region when compared with the general population. These anomalies include a flat occiput, oblique palpebral fissures, epicanthal folds, speckled irides, a protruding tongue, prominent malformed ears, and a flat nasal bridge.

Hearing impairment and otological problems including otitis media are still found in 38-90% of children with Down syndrome compared to 2.5% of normal children [1]. In DS, there is a clear increased incidence of congenital temporal bone anomalies, external auditory canal stenosis, mid-facial hypoplasia, poorly functioning Eustachian tube, comparatively small postnasal space, poor muscle tone, transmission rates that are accelerated at the brainstem or delayed at the cortex and a weak immunity [2]. All DS patients should undergo hearing assessment in the neonatal period, with follow-up as appropriate. Aggressive treatment of conductive hearing loss and early amplification may be necessary to maximize speech and language development [3].

Guidelines issued by NICE [3] recommend that DS children with Otitis Media with Effusion (OME) should be recommended hearing aid amplification and grommet insertion should be considered with caution after considering the several factors. This includes the child’s age, severity of hearing loss, practicality and heightened risks of surgery. Whilst these recommendations are correct there is concern that children with DS are being discouraged from undergoing grommet insertion. We wished to look at our experience in the light of the NICE guidelines and to assess parental satisfaction with grommet insertion.


This was a retrospective case study review and telephone questionnaire. We completed it in two phases, one in 2005 to 2006 and the other 2011 to 2012. It included 75 children with Down’s syndrome referred to a tertiary ENT and audiology service centre for Otitis Media with Effusion (OME).

The review looked at indications for ventilation tubes insertion and associated sensorineural hearing loss. The use of hearing aids, surgical management of OME and the complications involved were closely assessed. We also looked at the number of repeated insertions and time to extrusion of the grommets. As part of a quality assessment and patient satisfaction survey, parents were also asked whether they were satisfied with the procedure and whether they would have it done again.


Seventy-five children with Down’s syndrome were included in the study. OME with a conductive hearing loss was diagnosed in 61 (81%) patients. The mean conductive loss in those tested with pure tone audiometry was 50dB. 52 (85%) patients had ventilation tubes inserted (Table 1).