SCLEROSIS OF THE MASTOID AIR CELLS AS AN INDICATOR OF UNDIAGNOSED OTITIS-MEDIA IN CHILDREN WITH DOWNS-SYNDROME

We hypothesized that many children with Down's syndrome have undiagnos ed otitis media. In a 1989 study of lateral neck radiographs of 22 chi ldren with Down's syndrome, we found that 64% had sclerosis of the mas toid air cells, indicating untreated or inadequately treated otitis me dia. We reviewed the lateral neck radiographs of 53 children with Down 's syndrome and interviewed their parents regarding the diagnosis of o titis media. Mastoid air cells were found to be sclerotic in 22 (42%) of study subjects; 32% of these had no known history of otitis media. For the 68% of children diagnosed as having had otitis media, the most common symptoms were fever (61%) and cough or coryza (58%). Sclerosis of the mastoid processes was not associated with a high frequency of otitis media (>20 episodes) or a higher frequency of hearing loss, but was associated with subsequent myringotomy and insertion of a ventila tory tube (P = .038). Our finding of sclerotic mastoids in 42% of chil dren with Down's syndrome raises the possibility that children with Do wn's syndrome have unidentified or inadequately treated episodes of ot itis media.