Understanding the Tympanostomy Tube Dry-Tap Rate in Patients with down Syndrome

Introduction: Anatomic and physiological characteristics of patients with Down syndrome result in an increased risk of Eustachian tube dysfunction and development of otitis media with effusion with associated conductive hearing loss. It is reported that 30-88% of patients with Down syndrome receive tympanostomy tubes, and on average require 2-3 sets of tympanostomy tubes over their lifetime, which can result in long-term complications such as development of tympanic membrane perforation or cholesteatoma. To date, no studies have assessed the prevalence of aerated middle ears at the time of tube placement in patients with Down syndrome, which is relevant as some aerated ears may not require tubes.

Methods: A retrospective chart review was conducted at a pediatric tertiary care hospital. Pediatric patients with Down syndrome and age-matched control patients without Down syndrome or cleft palate/lip who underwent ear tube placement 1/2019-11/2024 were included. Surgical and audiometric records were reviewed. A dry tap occurred when there was no middle ear fluid at the time of surgery.

Results: 750 ears from 242 patients with Down syndrome underwent 395 unique procedures for tympanostomy tube placement 1/2019-11/2024. 577 (76%) cases occurred in patients who were ages 1-7 years old, and 469 (63%) cases were the only tubes placed for those patients during the review period. 750 ears from patients without Down syndrome or cleft palate/lip were identified as the age-matched control group.

The overall dry-tap rate in the patients with Down syndrome was 30% (222/750) compared with 26% (194/750) in the control group (p=0.11). When considering only those cases performed on patients 1-7 years old, the dry-tap rate in patients with Down syndrome was 29% (166/577) compared with 24% (136/577) in the control group (p=0.044).

Conclusions: Most tympanostomy tubes are placed in pediatric patients who are less than 7yrs old, and the dry tap rate in patients ages 1-7yrs old was greater for patients with Down syndrome compared to the control group. Patients with Down syndrome may be over treated with tympanostomy tubes.