Endoscopic Approach for Tympanostomy Tube Insertion in Patients With Trisomy 21

Otitis media with effusion (OME) is common in children with Down syndrome (DS), affecting 93% of children by age 1 year and 68% of children by age 8 years ( 1,2 ). Resultant conductive hearing loss is present in up to 80% of children with DS and OME, making prompt treatment imperative to prevent adverse effects on language and development ( 2-4 ). Placement of tympanostomy tubes is common treatment for chronic OME with associated conductive hearing loss. However, tympanostomy tube insertion can be challenging in the DS population due to stenotic external auditory canals, a morphologically defining characteristic of DS seen in 40 to 50% of individuals ( 4 ). Adequate visualization is paramount not only for safe tympanostomy tube placement but also to allow for surveillance for retraction pockets, atelectasis, and cholesteatoma. Here, we demonstrate how the use of an endoscope can improve visualization and aid in difficult tube placement in this patient population.