ASPO039 - Hearing, Speech Outcomes and Complications After Tympanostomy Tube Insertion for Children with Trisomy 21: A Systematic Review and Meta-Analysis
Saturday, April 30, 2022
4:00 PM – 4:55 PM CT
Location: Landmark C
Ghedak Ansari, MD1, Austin Swisher, BA2, Lydia Briggs, BS3, Elias Saba, MD1, Samuel Collazo, MD1, Shane Zim, MD1, Luke Schloegel, MD1;
1Head and Neck Surgery, Kaiser Permanente-Oakland, Oakland, CA, 2Univ. of California, Riverside Sch. of Med., Riverside, CA, 3Drexel Univ. Sch. of Med., Philadelphia, PA.
Introduction: Children with Trisomy 21 are at higher risk for conductive hearing loss for a variety of reasons both anatomical and functional. While treatment with tympanostomy tubes has been the standard of care in cases of middle ear effusion, the efficacy in terms of hearing and speech outcomes, in addition to potential negative short- and long-term outcomes have not been systematically reviewed.
Methods: A systematic review in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and standardized bias assessment using the Joanna Briggs Institute Critical Appraisal Checklist was performed.
Results: Fourteen studies were included, with nine retrospective, four prospective observational studies, and one descriptive study. Four studies reported short-term (1 year or less) hearing outcomes, and four on long-term (more than a year) hearing outcomes. Six studies report long-term hearing that is worse in children with T21 and attribute those findings to potential conductive hearing loss and repeat tube insertions. Two studies based on the same longitudinal data report that long term hearing is not negatively affected despite repeat tubes in this population. Only one study reported speech outcomes, and these were subjectively measured after tube insertion. Most articles focused on increased complication rates and the need for repeat tube placement. Level of evidence in the included studies ranged from 2b to 4 and all studies had an overall low risk of bias.
Conclusion: Urgent and expedited surgical management of middle ear effusion in children with Trisomy 21 may not lead to improved hearing and speech outcomes in this population and is associated with increased complications. The benefits of ventilation tubes in this population should be weighed against the potential complications and worse hearing and speech outcomes as compared to the general pediatric population.