Diagnosis and therapy for airway obstruction in children with down syndrome

Objectives: To document the causes of upper airway obstruction in a population of children with Down syndrome and to highlight the role of associated comorbidities. Design and Setting: Review of 23 cases involving children with Down syndrome who were referred for upper airway obstruction over a 21/2-year period to the Pediatric Otolaryngology Service of the University of New Mexico, Albuquerque. Methods: Data on the following variables were obtained: reason for referral, demographics, diagnosis, surgical procedures, complications, and comorbidities. Results: The children ranged in age from 1 day to 10.2 years (mean age, 1.8 years; median age, 6 months). Thirteen children were male and 10 were female. None of the children had subglottic stenosis. Laryngomalacia was the primary diagnosis in 10 children (43%), 8 of whom were younger than 1 month. Obstructive sleep apnea was the primary diagnosis in 11 children (48%), 8 of whom were older than 2 years. All children with obstructive sleep apnea and 4 children with laryngomalacia had a secondary ear, nose, and throat disorder. Gastroesophageal reflux was a comorbidity in 14 children (61%). Conclusions: The causes, severity, and presentation of upper airway obstruction in children with Down syndrome are related to the age of the child and to associated comorbidities. The treatment of comorbidities and secondary ear, nose, and throat disorders is an integral component of the surgical management of upper airway obstruction in such cases.