Ear, Nose and Throat Problems with Down Syndrome

Children with Trisomy 21 (Down syndrome) tend to experience problems with their ears, noses and throats. A specialized and highly trained team of experts like ours at Children's Hospital can follow these conditions closely and recommend the best treatments for your child.

Following are the more common conditions your child may face, along with recommended advice.

In 40 to 50 percent of children with Down syndrome the ear canals are very narrow. This can make it hard for us to examine the ear drum and middle ear space. It also results in ear wax buildup. We will need to see these children at least every three months until the ear canals have grown. We will check for middle ear disease and make sure your child can hear well.

Eustachian tube dysfunction is common. This can lead to repeated ear infections, sometimes with ear fluid buildup. Many children with Down syndrome will need tympanostomy tubes to prevent these problems.

Hearing loss is also common. the vast majority from difficulties with conducting sound (often helped with tympanostomy tubes). Four to 20 percent of these children may also have a mixed or sensorineural loss (hearing loss related to the brain process of sensation). Hearing testing will be performed routinely on such children to identify any hearing loss.

Speech disorders, such as speech delay, are common. Your child's voice may be gruff or harsh. Speech evaluation and therapy may help.

Obstructive sleep and disordered breathing are very common in children with Down syndrome. Some reports indicate that 100 percent of children with Down syndrome have sleep apnea. Often the tonsils and/or adenoids cause major problems. Removal these tissues is often necessary. Unfortunately, a low underlying tone of pharyngeal muscles, relatively large tongue, low skull base position and large body can also contribute. Some children respond well to use of a CPAP (continuous positive airway pressure therapy) device after surgery.

Your child's airway may be narrower than in a child without Down syndrome. Problems with the trachea can lead to breathing difficulty. Laryngomalacia (floppy voicebox) is common in infancy.

We also often see chronic runny nose (rhinitis) and swollen sinuses (sinusitis). Narrow nasal passages, low skull bases, poorly developed sinuses and possible allergic or immune factors lead to these symptoms. It's important to help your child maintain nasal hygiene with nasal saline sprays. You can use an aerosol spray such as Simply Saline, Nasamist or Ocean Mist five or more times a day, or more if your child is developing an upper respiratory infection.

Anesthesia can be risky for children with Down syndrome. Seek surgery only where the pediatric anesthesiologists understand your child's unique issues. They may need specialized X-rays of the neck ("flexion/extension") before surgery.