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Sclerosis of the Mastoid Air Cells as an Indicator of Undiagnosed Otitis Media in Children With Down's Syndrome

University of Chicago Pritzker School of Medicine, La Rabida Children's Hospital and Research Center, Chicago, Illinois, Wyler Children's Hospital, Chicago, Illinois

Vesna Martich

Cincinnati Children's Hospital, Cincinnati, Ohio

Tamar Ben-Ami

Wyler Children's Hospital, Chicago, Illinois

Madeleine U. Shalowitz

University of Chicago Pritzker School of Medicine, La Rabida Children's Hospital and Research Center, Chicago, Illinois

David K. Yousefzadeh

Cincinnati Children's Hospital, Cincinnati, Ohio

We hypothesized that many children with Down's syndrome have undiagnosed otitis media. In a 1989 study of lateral neck radiographs of 22 children with Down's syndrome, we found that 64% had sclerosis of the mastoid air cells, indicating untreated or inadequately treated otitis media. We reviewed the lateral neck radiographs of 53 children with Down's syndrome and interviewed their parents regarding the diagnosis of otitis 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 ventilatory tube (P= .038). Our finding of sclerotic mastoids in 42% of children with Down's syndrome raises the possibility that children with Down's syndrome have unidentified or inadequately treated episodes of otitis media.

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