Abruzzo–Erickson syndrome (often shortened to AES) is an extremely rare, inherited condition that affects several parts of the body from birth. The most common signs are problems of the roof of the mouth (cleft palate or a very high arch), hearing loss, an eye defect called coloboma (a notch or gap in eye structures), short height, and bones of the forearm that are joined together (radio-ulnar synostosis). Some babies with AES can also have male genital differences such as hypospadias, large or protruding ears, flat cheekbones, wide spacing between the second and third fingers, and sometimes heart differences. Doctors think AES happens because of changes (mutations) in a gene on the X chromosome called TBX22, which is important for normal face, palate, ear, limb, and urogenital development. The condition follows an X-linked recessive inheritance pattern. That means it mainly affects boys, and mothers can be healthy carriers. Genetic Diseases Info CenterOrphaNCBI+1
Abruzzo–Erickson syndrome (AES) is an ultra-rare, inherited condition that affects several body systems from birth. The most consistent features are cleft palate (an opening in the roof of the mouth), eye coloboma (a gap in eye structures), hearing loss, short stature, urologic differences such as hypospadias in boys, and sometimes radio-ulnar (forearm) synostosis (the two forearm bones are joined and do not rotate normally). In most families reported so far, AES follows an X-linked recessive inheritance pattern and is linked to changes (variants) in the TBX22 gene, which helps guide development of the face and palate during early pregnancy. Because AES is so rare, the number of published patients is very small, so the full range of features is still being described. Genetic Diseases Info CenterOrphaNCBI+1
Other names
Doctors and databases may use different names for the same condition. You might see:
CHARGE-like syndrome, X-linked
Cleft palate–coloboma–deafness syndrome (or cleft palate–coloboma–hearing loss syndrome)
Abruzzo–Erikson syndrome (spelling variant)
These names reflect the main features and the X-linked inheritance. Mouse Genome InformaticsZFINGlobal Genes
Types
There are no official, universally accepted subtypes of Abruzzo–Erickson syndrome. Because the condition is so rare, doctors often describe people by their main feature pattern. Thinking in these phenotypic groupings can help families and clinicians plan testing and care:
Palate-predominant pattern: cleft palate, very high-arched palate, or bifid uvula are the most obvious findings; hearing loss and other features may be mild. (TBX22 is a known cause of X-linked cleft palate.) NCBI
Eye-and-ear pattern: eye coloboma plus hearing loss and large, protruding ears; palate differences may also be present. NCBI
Skeletal-limb pattern: radio-ulnar synostosis (fusion of the forearm bones) with short stature and hand differences (e.g., wide gap between the 2nd and 3rd fingers). Wikipedia
Urogenital-predominant pattern: hypospadias in males with some or all of the other features. Orpha
These “types” are clinical groupings, not genetic subtypes. A single TBX22 change can produce different mixes of features even within the same family (variable expressivity). Genetic Diseases Info Center
Causes
Core cause (genetic):
TBX22 loss-of-function variants (mutations). Changes in TBX22 can stop the protein from working. This disrupts normal development of the palate, face, ears, limbs, and genitals. NCBI
TBX22 splice-site variants. These change how the gene’s message is cut and joined, producing a faulty protein; such variants are linked to X-linked cleft palate and AES-like features. Wikipedia
TBX22 missense variants. A single amino-acid change may reduce DNA-binding or transcription control by TBX22, lowering gene activity where it is needed during fetal growth. Wikipedia
Frameshift or nonsense variants. These introduce premature stop signals, leading to truncated, nonfunctional TBX22 proteins. Wikipedia
X-linked recessive inheritance. Because TBX22 is on the X chromosome, boys (with one X) are usually affected if that X carries the variant; carrier mothers are often unaffected or very mildly affected. Orpha
Developmental mechanisms (how one gene change causes multiple features):
Disrupted palatogenesis. TBX22 helps form the secondary palate; when it is faulty, the palate may not close, causing cleft palate or a very high arch. NCBI
Abnormal neural crest cell patterning. These cells help build facial bones, ear structures, and parts of the eye; disturbed signaling can cause flat cheekbones, ear shape differences, and coloboma. (Mechanistic inference consistent with TBX22’s craniofacial role.) NCBI
Failed optic fissure closure. Coloboma arises when the embryonic eye’s fissure does not close completely. TBX22-related craniofacial dysregulation can contribute to this. (Mechanistic inference.) NCBI
Ear development defects. Inner/middle ear malformations can cause mixed (conductive and/or sensorineural) hearing loss. Global Genes
Forearm segmentation errors. If the radius and ulna fail to separate properly, they may fuse (radio-ulnar synostosis). Orpha
Urethral development differences. Hypospadias results from altered urethral fold development in male fetuses and can be part of the AES pattern. Orpha
General growth pathway disruption. Some children have short stature, likely reflecting multi-system developmental effects. Genetic Diseases Info Center
Risk-modifying and explanatory factors (what shapes variability):
X-inactivation in carrier females. Random X-inactivation may “turn off” the normal or altered TBX22 in different cells, explaining mild findings in some females. (Well-known X-linked principle; applied to AES.) Orpha
Genetic background (modifier genes). Other genes can soften or intensify features, explaining why family members differ. (General principle in rare syndromes.)
Type and location of the TBX22 variant. Missense vs truncating changes can have different effects on the protein and the phenotype. Wikipedia
Regulatory (non-coding) variants. Changes near TBX22 that affect when and where it turns on may contribute in some families. (Mechanistic inference consistent with gene regulation.)
De novo variants. A new TBX22 change can arise for the first time in a child without a family history. (General genetic principle; X-linked disorders can be de novo.)
Undetected mosaicism in a parent. A parent may carry the variant in some cells (including eggs/sperm) but appear unaffected, increasing recurrence risk. (General genetic principle.)
Environmental modifiers. While AES is genetic, prenatal exposures rarely can modify severity of palate or ear anomalies; they do not cause AES by themselves. (Framing; not specific to TBX22.)
Diagnostic misclassification with CHARGE. Overlap with CHARGE can delay the correct label; better genetic testing reveals TBX22-related AES. Wikipedia
Symptoms and signs
Cleft palate – an opening in the roof of the mouth that affects feeding, speech, ear health, and dental alignment; often needs surgical repair. Genetic Diseases Info Center
Very high-arched palate or bifid uvula – milder palate differences that still affect speech or ear pressure. NCBI
Hearing loss (mixed or sensorineural) – trouble hearing soft sounds; may need hearing aids or other supports. Global Genes
Eye coloboma – a notch or gap in parts of the eye (iris or retina) that can reduce vision or cause light sensitivity. Genetic Diseases Info Center
Short stature – height below average for age due to multi-system developmental effects. Genetic Diseases Info Center
Radio-ulnar synostosis – the two forearm bones are joined, limiting rotation (turning the palm up or down). Orpha
Wide gap between the 2nd and 3rd fingers – a minor hand difference sometimes seen in AES. NCBI
Ulnar deviation – the hand or fingers angle outward a bit; usually mild but can affect grip. Wikipedia
Hypospadias (males) – the urethral opening is on the underside of the penis; may need surgical repair. Orpha
Large or protruding ears – a distinct external ear shape often noted on exam. NCBI
Flat cheekbones (flat malar area) – contributes to facial appearance; does not usually need treatment. NCBI
Facial asymmetry – mild unevenness of facial features. Wikipedia
Dental differences – crowding, malocclusion, or enamel issues related to palate shape. Wikipedia
Speech and feeding problems – due to palate differences and ear fluid; improve after surgical and speech-therapy care. Genetic Diseases Info Center
Congenital heart differences (occasionally) – some reports mention heart defects; screening is often considered. Wikipedia
Diagnostic tests
A) Physical examination (bedside assessment)
Newborn and infant exam. Doctors look at the face, mouth, ears, hands/forearms, eyes, genitals, chest, and spine for typical signs like cleft palate, coloboma, ear shape, and forearm motion limits. This guides which tests to do next. Genetic Diseases Info Center
Growth measurements. Height, weight, and head size are tracked on charts to see if short stature is present and to plan nutrition and endocrine review. Genetic Diseases Info Center
Palate and speech evaluation. Inspection of the mouth and listening to speech help grade palate problems and decide on timing for repair and therapy. Genetic Diseases Info Center
Eye exam with light (penlight/slit-lamp screening). A clinician can see an iris coloboma and decide if detailed eye imaging is needed. Genetic Diseases Info Center
Musculoskeletal exam of arms and hands. Range of motion testing of forearm rotation plus inspection for wide finger spacing or ulnar deviation points toward radio-ulnar synostosis. Orpha
B) Manual or office-based tests (simple tools at the visit)
Otoscopy and tympanometry. Looking into the ear and measuring eardrum movement identify fluid or eardrum problems that worsen hearing in children with palate issues. Global Genes
Vision acuity screening and refraction. Age-appropriate eye charts and lens testing estimate visual impact of coloboma and guide glasses or low-vision aids. Genetic Diseases Info Center
Bedside developmental screening. Simple questionnaires and play-based checks look for speech delays due to hearing and palate issues and help plan early therapy. Genetic Diseases Info Center
C) Laboratory and pathological tests
Genetic testing: targeted TBX22 sequencing. Looks for disease-causing variants in TBX22; confirms an AES-spectrum diagnosis and informs family counseling. NCBI
Deletion/duplication analysis of TBX22. Detects larger changes in or near the gene that standard sequencing might miss. NCBI
Chromosomal microarray (CMA). Screens the genome for extra/missing DNA segments; helpful if features overlap with other syndromes. (AES is usually single-gene, but CMA is common in syndromic workups.) NCBI
Exome or genome sequencing. Broader testing if targeted tests are negative but clinical suspicion for an X-linked craniofacial syndrome remains. (Useful because AES is ultra-rare and can mimic other syndromes.) NCBI
Carrier testing for mothers and at-risk female relatives. Identifies TBX22 variants in the family and clarifies recurrence risks. Orpha
Prenatal and preimplantation genetic testing (when family variant is known). Options to detect the TBX22 variant during pregnancy or before embryo transfer. (General genetics standard; applies when a familial variant is known.)
D) Electrodiagnostic tests
Newborn hearing screen with OAE (otoacoustic emissions). Quick, painless ear test that checks inner-ear hair cell function; many AES babies need early hearing follow-up. Global Genes
Auditory brainstem response (ABR). Measures how the hearing nerve and brainstem respond to sounds; defines the degree/type of hearing loss to guide hearing aids or other devices. Global Genes
Electrocardiogram (ECG) when indicated. Some clinicians screen heart rhythm and function if structural heart differences are suspected from exam or history. (Supportive assessment in syndromic care.)
E) Imaging tests
Forearm X-rays. Show radio-ulnar synostosis (fusion) and help orthopedic planning. Orpha
Temporal bone CT or ear MRI. Looks at middle and inner ear structures to explain hearing loss and plan treatment (e.g., hearing aids, bone-anchored devices). Global Genes
Comprehensive ophthalmic imaging (slit-lamp photos, OCT, ocular ultrasound when needed). Defines the extent of coloboma and guides visual rehabilitation. Genetic Diseases Info Center
Non-pharmacological treatments
(Grouped as requested: 15 physiotherapy modalities, plus mind-body, gene-therapy context, and educational therapies. For each: description → purpose → mechanism → benefits.)
A. Physiotherapy & rehabilitation
Early feeding therapy (cleft-palate–aware)
What: Guided positioning, special nipples/bottles, pacing feeds.
Purpose: Safe nutrition and weight gain before/after palate repair.
How: Optimizes latch and flow; reduces nasal regurgitation.
Benefits: Better growth, fewer aspiration events.Oro-motor therapy
Targets tongue, lip, and soft-palate coordination.
Improves swallow, decreases nasal air escape; clearer speech; safer feeding.Speech-language therapy (long term)
Addresses articulation, resonance (hypernasality), and language delays common with cleft palate and hearing loss.
Uses targeted drills and resonance therapy; supports social/academic communication.Aural (listening) rehabilitation
Trains the brain to use sound via hearing aids/implants; lip-reading and communication strategies.
Improves classroom function and safety awareness.Vestibular/balance training
If inner-ear issues cause imbalance, graded exercises improve postural control.
Reduces falls; supports gross-motor milestones.Physiotherapy for radio-ulnar synostosis
Range-of-motion within safe limits; compensatory shoulder/wrist strategies; activity modification.
Maximizes independence in daily tasks when rotation is limited.Hand therapy & adaptive tools
Custom grips, angled utensils, and task-specific training.
Enhances self-care (e.g., eating, writing, dressing).Post-operative rehabilitation (urology/orthopedics/ENT/craniofacial)
Protects surgical sites, gradually restores function.
Shortens recovery time; reduces scarring/contractures.Respiratory physiotherapy (as needed)
Airway clearance techniques if recurrent infections.
Improves ventilation; fewer hospital visits.Vision rehabilitation
Low-vision strategies, protective eyewear for coloboma, contrast/lighting optimization.
Better reading/navigation; injury prevention.Fine-motor and sensory integration therapy
For hand skills and sensory processing affected by hearing/vision challenges.
Improves handwriting, play, and classroom participation.Postural training & core strengthening
Addresses compensation from limb limits and balance issues.
Reduces pain/fatigue; supports endurance.Pain management without drugs
Heat/cold, TENS (under supervision), gentle manual therapy.
Less reliance on analgesics; improved activity tolerance.Nutritional counseling for cleft-related feeding issues
Calorie-dense options in small volumes; texture staging.
Supports growth and wound healing.Care-coordination coaching for families
Teach how to navigate multidisciplinary teams and follow-ups.
Prevents missed care; reduces stress.
B. Mind–body supports
Family-centered counseling
Coping skills, sibling support, expectations for surgeries/therapies.
Lower caregiver burnout; improved adherence.Age-appropriate peer support
Links with cleft/hearing-loss communities.
Normalizes differences; boosts resilience.Mindfulness and stress-reduction for procedures
Breathing/relaxation around hospitalizations.
Better cooperation; lower peri-procedural anxiety.Social-skills coaching
Role-play communication strategies (especially with hearing/voice differences).
Improves confidence and inclusion.
C. Gene therapy—current status
Gene-therapy context (informational only)
There is no approved gene therapy for AES/TBX22 today. Craniofacial gene repair is an active research area, but human clinical treatments are not available; care is supportive/surgical. Families can consider research registries when available. (This cautious stance reflects current evidence about TBX22-related clefting; routine clinical gene therapy doesn’t exist yet.) Wikipedia
D. Educational therapies
Individualized Education Plan (IEP)
Hearing/vision accommodations, speech therapy minutes, preferential seating, FM/remote-microphone systems.
Improves access to instruction.Teacher of the Deaf/Hard of Hearing (TOD/HI)
Classroom strategies, captioning, note-taking support.
Boosts academic progress and participation.Vision services
Large-print or high-contrast materials; lighting control.
Reduces visual strain; better learning.Augmentative & alternative communication (AAC) when needed
Picture boards/tablets if speech is severely affected early on.
Ensures communication during crucial developmental periods.Transition-to-adulthood planning
Self-advocacy, vocational guidance, workplace accommodations.
Supports independence and employment.
Drug treatments
Important safety note: There is no medicine that “cures” Abruzzo–Erickson syndrome. Drugs are used to treat specific symptoms or complications (ear infections, post-op pain, reflux, eye dryness, etc.). Dosing varies by age/weight/other conditions; always follow a clinician’s instructions. The examples below list typical classes and purposes rather than individualized doses.
Analgesics/antipyretics (e.g., acetaminophen) – post-operative pain/fever control after palatoplasty, ear tube placement, or hypospadias repair.
NSAIDs (e.g., ibuprofen) – additional pain/anti-inflammatory effects when appropriate.
Topical ophthalmic lubricants (artificial tears/ointments) – protect exposed ocular tissues in iris/retinal coloboma-related dryness.
Antibiotic ear drops (e.g., ofloxacin) – after tympanostomy tubes if otorrhea occurs.
Systemic antibiotics (e.g., amoxicillin) – for acute otitis media when indicated.
Intranasal corticosteroids (e.g., fluticasone) – reduce nasal mucosal swelling that can worsen middle-ear ventilation in allergic patients.
Saline nasal sprays/irrigation – non-drug adjunct but often charted; improves nasal hygiene around palate surgery periods.
Acid suppression (e.g., omeprazole) – for reflux that aggravates postoperative throat discomfort or feeding.
Antiemetics (e.g., ondansetron) – peri-operative nausea/vomiting control.
Ophthalmic antibiotics (e.g., erythromycin ointment) – for surface infections; not for routine use in coloboma.
Intraocular pressure–lowering drops (e.g., timolol, latanoprost) – only if glaucoma develops in an eye with structural anomalies; requires ophthalmologist oversight.
Allergy antihistamines (e.g., cetirizine) – for allergic rhinitis that may worsen Eustachian tube dysfunction.
Vitamin D and calcium (medically prescribed forms) – when deficiency is documented; supports bone health during growth/surgeries.
Iron therapy – only if iron-deficiency anemia is confirmed.
Topical steroid creams – for post-surgical skin irritation or dermatitis near hearing devices; used sparingly under guidance.
(The “no cure—symptom-based treatment” conclusion is consistent with rare-disease summaries; clinical care targets each involved organ system.) WikipediaGenetic Diseases Info Center
Dietary “molecular” supplements
Caution: Supplements are not proven treatments for AES. Use only if a clinician agrees, to avoid interactions with surgeries or medicines.
Vitamin D3 – supports bone and immune health; base on blood levels/RDA.
Calcium – paired with D when intake is low.
Omega-3 (fish oil) – general anti-inflammatory support; may aid dry eye symptoms.
Lutein/zeaxanthin – eye-health antioxidants (helpful for retinal metabolism; not a coloboma fix).
B-complex with B12/folate – supports energy and hematologic health; follow RDAs.
Zinc – wound healing and immune function; avoid excess.
Probiotics – GI tolerance after antibiotics.
Vitamin A (retinol) – vision/epithelium support; avoid excess (teratogenic in pregnancy).
Magnesium – muscle/nerve function; can help constipation from pain meds.
Protein-dense oral nutrition (whey/casein/pea blends) – growth and post-op healing when intake is limited.
Regenerative / stem-cell drugs
Straight talk: There are no approved “immunity booster,” regenerative, or stem-cell drugs to treat AES or to regrow palate/eye/forearm structures. Stem-cell and gene-editing approaches are experimental in craniofacial biology and not part of standard care for TBX22-related disorders. Using unregulated “stem-cell” products can be dangerous. Instead, families can:
Enroll in registries/clinical studies if offered by credible centers.
Focus on proven interventions (surgery, hearing/vision supports, therapy, nutrition). Wikipedia
Surgeries
Palatoplasty (cleft-palate repair)
What: Surgical closure of the palate, usually in infancy.
Why: Enables normal speech development, better feeding, and reduces ear complications.Tympanostomy tubes (ear tubes)
What: Ventilation tubes in the eardrum.
Why: Treats recurrent middle-ear fluid/infections that worsen hearing and speech delays.Hypospadias repair (urethroplasty)
What: Straightens and reconstructs the urethra to the tip of the penis.
Why: Improves urinary stream, hygiene, and future sexual/reproductive function.Surgery for radio-ulnar synostosis (derotational osteotomy in select cases)
What: Repositions forearm bones when function is severely limited.
Why: Improves reach and self-care tasks (e.g., feeding, personal hygiene).Ocular procedures for coloboma (selected cases)
What: Iris coloboma—cosmetic/functional repairs (iridoplasty or artificial iris). Chorioretinal coloboma—retinal detachment repair if complications arise; protective strategies otherwise.
Why: Reduce light sensitivity and cosmetic concerns (iris), manage serious complications (retina).
(AES care is multidisciplinary—craniofacial/plastic surgery, ENT, audiology, ophthalmology, orthopedics, urology, genetics.) Genetic Diseases Info CenterOrpha
Prevention & proactive steps
Genetic counseling for families with a known TBX22 variant (X-linked recessive pattern).
Carrier testing for at-risk female relatives when appropriate.
Prenatal options: targeted ultrasound; if a familial variant is known, discuss diagnostic testing.
Vaccinations on schedule (helps prevent ear/respiratory infections).
Avoidance of ototoxic exposures (very loud noise, unnecessary ototoxic drugs).
Early hearing support (hearing aids/remote microphones) to prevent language delay.
Protective eyewear for coloboma to reduce injury risk.
Good oral/nasal hygiene to lower ENT infections around palate repair.
Nutrition optimization (adequate protein, vitamins) to support growth and surgery recovery.
Regular follow-up with the full care team to catch issues early.
When to see a doctor
Poor feeding, choking, or slow weight gain in infancy.
Ear drainage, fever, or suspected hearing decline.
Light sensitivity, eye pain, new floaters/“curtain” in vision (possible retinal event).
Urinary problems or penile curvature in boys.
Elbow/forearm pain, new loss of function, or injuries.
Speech not progressing, very nasal voice, or unclear words beyond expected age.
Any post-operative fever, bleeding, or wound concerns.
What to eat & what to avoid
Eat more of:
Soft, high-protein foods during the cleft-palate period (yogurt, eggs, lentils, fish, nut butters if safe).
Iron-rich foods if advised (beans, leafy greens, meats) and vitamin C to aid absorption.
Calcium + vitamin D sources (dairy/fortified plant milks, small fish with bones).
Omega-3 sources (fish like hilsa/ruhi/salmon, or walnuts/flax) to support general eye and nerve health.
Hydration for mucus clearance and post-op recovery.
Avoid or limit:
Hard, sharp, or crumbly foods (chips, hard crackers) right after palate surgery.
Sticky foods that lodge in the palate or around ear tubes (caramels).
Excess sugar that fuels dental caries.
Unverified “immune boosters” or unregulated stem-cell products.
Smoking exposure around the child (worsens ENT issues).
Frequently asked questions
Is AES the same as CHARGE?
No. They overlap, but AES is X-linked and typically lacks some CHARGE features like choanal atresia. WikipediaWhat gene is involved?
TBX22 on the X chromosome in many reported families. OrphaHow rare is it?
Extremely rare—only a handful of cases published; exact frequency unknown. WikipediaCan girls be affected?
Yes, rarely—often more mildly—if they inherit the variant or due to X-inactivation patterns.Is there a cure?
No disease-modifying cure yet; care is supportive and surgical as needed. WikipediaWill my child speak normally?
Many children achieve good speech after palate repair plus therapy, especially with early hearing support.Does coloboma always cause severe vision loss?
No—impact varies by location/size; iris coloboma mainly causes glare/light sensitivity, while chorioretinal coloboma can affect vision more and needs monitoring.Are hearing aids always needed?
Not always; depends on the type and degree of hearing loss. An audiologist will guide options (aids, implants, classroom microphones).Why ear tubes?
They ventilate the middle ear to reduce fluid/infections and protect hearing during speech-critical years.Will my child be short forever?
Short stature is reported, but growth patterns vary. Your clinician will track growth and check for treatable causes.Can forearm surgery restore full rotation?
Surgery can improve functional positioning in selected cases, but may not restore normal rotation; therapy teaches compensations.Is hypospadias repair necessary?
Often recommended for urinary/functional reasons, but timing/type is individualized.Which specialists do we need?
Craniofacial/plastic surgery, ENT/audiology, ophthalmology, urology, orthopedics, genetics, speech/feeding therapy, PT/OT, dentistry, and primary care.Are there research studies?
Occasionally; ask your genetics team about registries or studies tracking TBX22-related conditions.What can we do right now?
Keep appointments, support hearing and speech, protect the eyes, ensure good nutrition, and lean on your care team and community supports.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: September 01, 2025.
