Down Syndrome as an indicator for pediatric otolaryngologic procedures
Introduction
Down Syndrome (DS) is the most common autosomal chromosome abnormality in humans. It comes with a host of medical conditions including mental retardation, cardiac abnormalities, respiratory problems, and many otolaryngologic manifestations [1]. As medical advancement has decreased the mortality of patients with DS, the issue of managing ear, nose, and throat (ENT) disease states is becoming more pressing. Some anatomic phenotypes found in DS patients that can lead to head and neck disease states are midface hypoplasia, micrognathia, inner ear dysplasia, macroglossia, and narrowing of the airway [1]. Common disease states include chronic ear disease, hearing loss, chronic rhinitis, vocal cord paralysis, and laryngomalacia [2].
Most of the current literature describes surgical outcomes of DS patients undergoing more common otolaryngologic procedures such as adenoidectomy, tonsillectomy, and tympanostomy tube placement [[3], [4], [5], [6]]. Surgical intervention in DS patients is complicated by multiple systemic comorbidities and certain anesthetic considerations like atlantoaxial instability [7,8]. There are only a few studies looking at the treatment of DS patients from a broad otolaryngologic perspective [2,[8], [9], [10]]. It is important for clinicians to understand the surgical needs of DS patients due to their many otolaryngologic disease states. Our goal is to use national data to study otolaryngologic procedures, their association with DS, and degree of difference in risk profiles encountered with DS.
Section snippets
Data source
Patient information was taken from the public use file for years 2012–2015 of the NSQIP-P. The NSQIP-P provides deidentified information from multiple institutions on surgical outcomes. Patient demographics and outcomes up to 30-days post-surgery were systematically collected for each case (Table 2). The NSQIP-P is not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Data collection and outcome measures
Patients undergoing otolaryngologic procedures were identified using a
Results
The NSQIP-P database from 2012 to 2015 contained 42,428 pediatric otolaryngologic cases. 502 (1.2%) patients had Down Syndrome (DS). The top six comorbidities prevalent were: asthma, esophageal/gastric/intestinal disease, cardiac risk factors, developmental delay/impaired cognitive status, structural pulmonary/airway abnormality, and nutritional support. Demographic information and comorbidities for the population of ENT patients are described in Table 2. Chi-square analysis showed that the DS
Discussion
This study examined the association between certain otolaryngologic procedures and Down Syndrome (DS). Chi-square and binomial logistic regression analysis identified eleven ENT procedure groups that are associated with DS patients. These associations likely arise from the otolaryngologic disease states found in DS patients. Mitchell et al. documented the reasons for which DS patients were referred to a pediatric otolaryngologist and found the most to be for upper airway obstruction (76%).
Conclusion
This study provides information on the association between Down Syndrome and otolaryngologic procedures. The analysis of the 2012–2015 NSQIP-P database has shown that DS is overrepresented into the Tracheostomy, Endoscopy, Laryngoplasty, Tracheoplasty, Myringoplasty, Tympanoplasty with Mastoidectomy, and Tympanoplasty without Mastoidectomy procedure groups. DS patients are significantly underrepresented in the Abscess, Palatoplasty, Excision of Congenital Neck Cyst, and Cochlear Implantation
Declarations of interest
None.
Source of funding
Funding for this study was supported by the National Institutes of Health (T32 DC0014435).
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