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Fountain Syndrome

Synonyms of Fountain Syndrome

  • Mental Retardation-Deafness-Skeletal Abnormalit.-Coarse Face with Full Lips

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Fountain syndrome is an extremely rare inherited disorder that is characterized by mental retardation; abnormal swelling of the cheeks and lips due to the excessive accumulation of body fluids under the skin (subcutaneous) of the face (edema); skeletal abnormalities; and/or deafness due to malformation of a structure (cochlea) within the inner ear. Fountain syndrome is inherited as an autosomal recessive trait.

Symptoms

Fountain syndrome is an extremely rare inherited disorder. In all cases reported in the medical literature, affected individuals have exhibited mild to severe mental retardation.

Individuals with Fountain syndrome may also exhibit several physical abnormalities. For example, fluid may abnormally accumulate under the skin (edema) of the face, especially the lips and cheeks. As a result, the face may appear coarse, abnormally "full," and swollen.

Fountain syndrome may also be characterized by deafness at birth (congenital deafness) due to a defect in a bony spiral organ in the inner ear (cochlea). In this type of deafness, although sound is transmitted normally through the external and middle ear, the cochlear malformation in the inner ear causes the hearing loss (congenital sensorineural deafness). The cochlea normally transforms sound vibrations into nerve impulses that are transmitted to the brain. Because congenital sensorineural deafness results in an inability to hear spoken language, affected infants and children may be unable to develop and comprehend verbal language structure, resulting in an inability to communicate through speech (deaf mutism).

Individuals with Fountain Syndrome may also have skeletal abnormalities including abnormal thickening of the cap of the skull (calvaria) and/or unusually broad, short, and stubby hands and feet. In addition, in some cases, affected individuals may exhibit extreme front-to-back curvature of the spine (hyperkyphosis) and/or short stature.

In some cases, individuals with Fountain syndrome may exhibit additional physical abnormalities. For example, during infancy, some individuals may experience episodes of repeated, uncontrolled electrical disturbances involving both sides of the brain (generalized seizures), short stature, an abnormally large head circumference (macrocephaly), and broad, plump hands.

Causes

Fountain syndrome is as an autosomal recessive trait. Genetic diseases are determined by two genes, one received from the father and one from the mother.

Recessive genetic disorders occur when an individual inherits the same abnormal gene for the same trait from each parent. If an individual receives one normal gene and one gene for the disease, the person will be a carrier for the disease, but usually will not show symptoms. The risk for two carrier parents to both pass the defective gene and, therefore, have an affected child is 25% with each pregnancy. The risk to have a child who is a carrier like the parents is 50% with each pregnancy. The chance for a child to receive normal genes from both parents and be genetically normal for that particular trait is 25%.

Affected Populations

Fountain Syndrome is an extremely rare inherited disorder that is believed to affect males and females in equal numbers. However, of the seven cases reported in the medical literature, six affected individuals were male and one was female. Reported cases include three brothers and one sister from one family, two brothers from another, and one male from a third family. Sensorineural deafness associated with Fountain Syndrome may be apparent at birth (congenital). Additional symptoms and physical characteristics that may be associated with the disorder usually become apparent during infancy or early childhood.

Related Disorders

Symptoms of the following disorders can be similar to those of Fountain Syndrome. Comparisons may be useful for a differential diagnosis:

Melkersson-Rosenthal Syndrome is a rare disorder characterized by swelling in certain areas of the face, particularly the upper and/or lower lips; recurrent loss of motor nerve function in muscles in one or both sides of the face (unilateral or bilateral facial nerve palsy); and/or, in some cases, the presence of deep grooves in the surface of the tongue that may radiate outward. In some cases, the facial swelling associated with Melkersson-Rosenthal Syndrome may also affect the forehead, eyelids, nose, and/or chin. Facial palsy tends to follow facial swelling, though, in some cases, it may occur before or in association with swelling. In many cases, affected individuals experience temporary, recurrent episodes of facial nerve palsy and swelling. However, in some cases, episodes of swelling may become more persistent and/or, rarely, facial nerve palsy may become permanent. Although the exact cause of Melkersson-Rosenthal Syndrome is unknown, it is thought to be inherited as an autosomal dominant genetic trait. (For more information on this disorder, choose "Melkersson-Rosenthal" as your search term in the Rare Disease Database.)

There are some additional congenital disorders that may be characterized by mental retardation occurring in association with coarse, full facial features; skeletal abnormalities; hearing impairment or deafness; and/or other physical abnormalities similar to those potentially associated with Fountain Syndrome. (For more information on these disorders, choose the exact disease name in question as your search term in the Rare Disease Database.)

Standard Therapies

Diagnosis
Fountain syndrome is usually diagnosed during infancy or early childhood, based upon a thorough clinical evaluation, characteristic physical findings, and a variety of specialized tests. For example, various audiological tests may be conducted to help assess the nature of the hearing loss, and an X-ray scanning procedure (computerized tomography or CT scan) may be performed to confirm inner ear (i.e., cochlear) malformation as the cause of sensorineural deafness in individuals with Fountain syndrome. During such CT scanning, a computer and X-rays are used to create a film showing cross-sectional images of the structures of the inner ear. X-ray studies may also be used to confirm the presence of certain skeletal abnormalities suspected during clinical observation.

If affected infants experience seizures, a complete neurological evaluation may be conducted including electroencephalography (EEG) and CT scanning. During an EEG, the brain's electrical impulses are recorded; such studies may reveal brain wave patterns that are characteristic of certain types of seizures. CT scanning may be used to create cross-sectional images of the brain's tissue structure.

Treatment
The treatment of Fountain syndrome is directed toward the specific symptoms that are apparent in each individual. Treatment may require the efforts of a team of specialists working together to systematically and comprehensively plan an affected child's treatment. Such specialists may include pediatricians; physicians who diagnose and treat disorders of the ears, nose, and throat (otolaryngologists); specialists who assess and treat hearing problems (audiologists); those who specialize in abnormalities of speech and language development (speech-language pathologists); specialists who diagnose and treat skeletal disorders (orthopedists); neurologists; physical therapists; surgeons; and/or other health care professionals.

Specific therapies for the treatment of Fountain syndrome are symptomatic and supportive. In some cases, various orthopedic techniques may be used to help treat and/or correct skeletal abnormalities associated with Fountain syndrome. For example, extreme front-to-back curvature of the spine (hyperkyphosis) may be treated with a combination of exercises and physical therapy, other supportive techniques, braces, and/or casts.

For individuals with Fountain syndrome who experience generalized infantile seizures, anticonvulsant drug therapy may be prescribed to help prevent, reduce, or control such seizures.

Early intervention is important in ensuring that children with Fountain Syndrome reach their potential. Services that may be beneficial may include special remedial education, special services for children with congenital sensorineural deafness and mutism, and other medical, social, and/or vocational services.

Genetic counseling may also be of benefit for affected individuals and their families. Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

Organizations related to Fountain Syndrome

(Please note that some of these organizations may provide information concerning certain conditions potentially associated with this disorder [e.g., mental retardation, deafness, skeletal abnormalities, seizures, etc.].)

References

TEXTBOOKS
Van Buggenhout GJ, Fryns JP. Fountain Syndrome. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:196.

Ballenger JJ, ed. Diseases of the Nose, Throat, Ear, Head & Neck, 14th ed. New York, NY: Lea & Febiger Co; 1991:1048-51.

Gorlin RJ, et al., eds. Syndromes of the Head and Neck, 3rd ed. New York, NY: Oxford University Press; 1990:835, 837.

Buyce ML, ed. Birth Defects Encyclopedia. Dover, MA: Blackwell Scientific Publications; For: The Center for Birth Defects Information Services Inc; 1990:312, 747.

JOURNAL ARTICLES
Van Buggenhout GJ, et al. Fountain syndrome: further delineation of the clinical syndrome and follow-up data. Genet Couns. 1996;7:177-86.

Fryns JP. Fountain's syndrome: mental retardation, sensorineural deafness, skeletal abnormalities, and coarse face with full lips. J Med Genet. 1989;26:722-24.

Fryns JP, et al. Mental retardation, deafness, skeletal abnormalities, and coarse face with full lips: confirmation of the Fountain syndrome. Am J Med Genet. 1987;26:551-55.

Fountain RB. Familial bone abnormalities, deaf mutism, mental retardation and skin granuloma. Proc R Soc Med. 1974;67:878-79.

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2008/03/28 00:00:00 GMT+0

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