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Otitis Media Vulnerability in Children with Down Syndrome Linked to Microbial Changes



Key takeaways

  • Our experts sought to better understand why children with Down syndrome have a greater recurrence of otitis media and more severe complications.

  • In the first known study of its kind, the research team analyzed changes in the microbiome of the middle ear and nasopharynx of patients with otitis media.

  • Study authors determined the overall composition of these bacterial profiles were different in children with Down syndrome.

  • Future studies will further clarify disease mechanisms and aid in selecting the best antibiotics to treat ear infections in children with Down syndrome.

Research study background

Children with Down syndrome have a higher incidence of otitis media, undergo more surgeries and experience worse outcomes than children without. Chronic otitis media with effusion is the most common cause of hearing loss in patients with Down syndrome. Previous studies reported that 90% of children with Down syndrome require ear tubes averaging almost 2.5 surgeries per child.

The immune homeostasis is known to be disrupted in children with Down syndrome, resulting in increased susceptibility to infections, but it has not been well studied for otitis media. These children also experience a high rate of eustachian tube dysfunction due to decreased muscle tone.

This study was a collaboration between pediatric otolaryngology experts at Children’s Hospital Colorado and the Frank and Santos-Cortez laboratories at the University of Colorado School of Medicine. The team hypothesized that patients’ heightened susceptibility to otitis media may be attributed to genetic factors associated with trisomy 21, such as decreased commensal and increased pathogen binding, leading to microbial disturbances.

Study authors obtained middle ear and nasopharyngeal samples from 105 pediatric patients undergoing surgery for otitis media, including 14 with Down syndrome. They sequenced the 16S rRNA genes and analyzed the data for variations in middle ear and nasopharyngeal microbiomes in children with Down syndrome diagnosed with otitis media to clarify the potential pathways contributing to these middle ear infections. Their findings are the first known published reports of these bacterial profiles.

Study results revealed that chronic otitis media with effusion occurred more frequently in patients with Down syndrome and that there were significant differences in otitis media surgery type, antibiotic history, and family history compared to those without Down syndrome. Changes related to Down syndrome were consistent across age and otitis media types. The team found the overall composition of the middle ear and nasopharynx bacterial profiles of children with Down syndrome was different than those without Down syndrome. Notably, there was a significant increase of drug and antibiotic-resistant bacteria in the middle ears of patients with Down syndrome, suggesting the need for broader antibiotic coverage.

Relevance to future research

Additional research including culture and sensitivity studies, long-term follow-up of microbiota in a larger cohort of children with Down syndrome and otitis media, and co-occurring immune and microbial profiles in the nasopharynx and middle ear, will help clarify disease mechanisms and guide antibiotic choices for otitis media.