Down's syndrome: A modern otorhinolaryngological perspective

Abstract

The incidence of Down's syndrome is estimated at 1.5 per 1000 births, or 7,000 newborns annually in this country. Mounting financial considerations in the delivery of medical care, as well as humanitarian considerations, fostered this in‐depth prospective, multidisciplinary study. One hundred and seven patients comprised the initial group, and 83 met the criteria established for documentation of otorhinolaryngological parameters. All patients were home based and given scheduled, routine pediatric care. Otolaryngology care, when indicated, was by consultation. The uniqueness of this study exists in the fact that children were followed from the first year of life, in what must be considered an enhanced environmental setting for Down's syndrome patients.Otologic, rhinologic and laryngologic parameters were explored in‐depth with the following resultant data. Patients with stenotic ear canals had a markedly increased incidence of associated middle ear effusion. In addition, patients with an increased frequency of upper respiratory tract infections in association with stenotic canals had an even greater incidence of effusion. When stenotic canals were present, the diagnosis of fluid proved difficult for the primary care physician. The total incidence of conductive middle ear pathology was shown to be significantly lower than in most reported studies. Equally important was the fact that at the time of data computation, none of the children had active, chronic middle ear pathology and cholesteatoma had not been identified.Adenoidectomy was shown clinically to have little apparent effect on the course of otologic pathology, nasal respiration or rhinorrhea in Down's syndrome. Previously unreported surgical correlates of the nasopharyngeal anatomy were related to upper respiratory obstructive symptoms manifest by many of these children. Apparent, spontaneous resolution of the latter, in most instances with age, correlated well with anticipated changes in the growth of the involved structures. Low dose antibiotic therapy was shown to be of benefit in controlling early rhinorrhea.Isolated congenital abnormalities of the lower respiratory tract were discussed with the findings that symptoms related to the respiratory tract must not be assumed to be inherent to the syndrome until other potential etiologies have been thoroughly considered.Factors relating to intelligence in Down's syndrome were explored with the conclusion that a direct and favorable comparison could be made in this study between improved hearing and improved intellect.