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Téblick S, Ruymaekers M, Van de Casteele E, Boudewyns A, Nadjmi N. The effect of soft palate reconstruction with the da Vinci robot on middle ear function in children: an observational study. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00045-0. [PMID: 36914451 DOI: 10.1016/j.ijom.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
Cleft palate is associated with a high prevalence of middle ear dysfunction, even after palatal repair. The aim of this study was to evaluate the effects of robot-enhanced soft palate closure on middle ear functioning. This retrospective study compared two patient groups after soft palate closure with a modified Furlow double-opposing Z-palatoplasty technique. Dissection of the palatal musculature was performed using a da Vinci robot in one group and manually in the other. Outcome parameters were otitis media with effusion (OME), tympanostomy tube use, and hearing loss during 2 years of follow-up. At 2 years post-surgery, the percentage of children with OME had reduced significantly to 30% in the manual group and 10% in the robot group. The need for ventilation tubes (VTs) decreased significantly over time, with fewer children in the robot group (41%) than those in the manual group (91%) needing new VTs during postoperative follow-up (P = 0.026). The number of children presenting without OME and VTs increased significantly over time, with a faster increase in the robot group at 1 year post-surgery (P = 0.009). Regarding hearing loss, significantly lower hearing thresholds were recorded in the robot group from 7 to 18 months postoperatively. To conclude, beneficial effects of robot-enhanced surgery were recorded, suggesting a faster recovery when the soft palate was reconstructed using the da Vinci robot.
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Affiliation(s)
- S Téblick
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - M Ruymaekers
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - E Van de Casteele
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Antwerp, Belgium; All for Research vzw, Antwerp, Belgium
| | - A Boudewyns
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - N Nadjmi
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium; Department of Craniomaxillofacial Surgery, Antwerp University Hospital, Edegem, Belgium; Department of Maxillofacial Surgery, ZMACK, AZ MONICA Antwerp, Antwerp, Belgium; OMFS Program, University of Antwerp, Antwerp, Belgium
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Maina G, Pollock D, Lockwood C, Ooi E. Effectiveness of ventilation tube insertion for conductive hearing loss in children with chronic otitis media with effusion and non-syndromic cleft palate: a systematic review protocol. JBI Evid Synth 2022; 20:1560-1567. [PMID: 35220383 DOI: 10.11124/jbies-21-00217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will investigate the efficacy of ventilation tube insertion versus non-surgical options in the management of chronic otitis media with effusion in children with non-syndromic cleft palate by assessing the degree of conductive hearing loss. INTRODUCTION Chronic otitis media with effusion is common in children with cleft palate due to associated eustachian tube dysfunction. It can lead to impaired hearing and can hinder speech and language development. The main treatment options are drainage of effusion with ventilation tubes, surveillance, or amplification with hearing aids. Each of these approaches has its advantages but there is currently no consensus on the most appropriate management in children with cleft palate. INCLUSION CRITERIA Eligible studies will include children (<18 years) with cleft palate not associated with a genetic syndrome, diagnosed with chronic otitis media with effusion, who have undergone insertion of ventilation tubes compared with either surveillance or amplification with hearing aids. METHODS A comprehensive search of MEDLINE, CINAHL, Embase, and Scopus will be conducted to find published literature. Gray literature searches will be conducted through the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and ProQuest Dissertations and Theses Global. Two reviewers will screen studies, conduct critical appraisal of eligible studies, assess the methodological quality, and extract the data. Where possible, studies will be pooled in statistical meta-analysis, with heterogeneity of data being assessed using the standard χ 2 and I2 tests. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021255861.
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Affiliation(s)
- Grace Maina
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Eng Ooi
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, SA, Australia
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Mink van der Molen AB, van Breugel JMM, Janssen NG, Admiraal RJC, van Adrichem LNA, Bierenbroodspot F, Bittermann D, van den Boogaard MJH, Broos PH, Dijkstra-Putkamer JJM, van Gemert-Schriks MCM, Kortlever ALJ, Mouës-Vink CM, Swanenburg de Veye HFN, van Tol-Verbeek N, Vermeij-Keers C, de Wilde H, Kuijpers-Jagtman AM. Clinical Practice Guidelines on the Treatment of Patients with Cleft Lip, Alveolus, and Palate: An Executive Summary. J Clin Med 2021; 10:jcm10214813. [PMID: 34768332 PMCID: PMC8584510 DOI: 10.3390/jcm10214813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open
Abstract
Significant treatment variation exists in the Netherlands between teams treating patients with cleft lip, alveolus, and/or palate, resulting in a confusing and undesirable situation for patients, parents, and practitioners. Therefore, to optimize cleft care, clinical practice guidelines (CPGs) were developed. The aim of this report is to describe CPG development, share the main recommendations, and indicate knowledge gaps regarding cleft care. Together with patients and parents, a multidisciplinary working group of representatives from all relevant disciplines assisted by two experienced epidemiologists identified the topics to be addressed in the CPGs. Searching the Medline, Embase, and Cochrane Library databases identified 5157 articles, 60 of which remained after applying inclusion and exclusion criteria. We rated the quality of the evidence from moderate to very low. The working group formulated 71 recommendations regarding genetic testing, feeding, lip and palate closure, hearing, hypernasality, bone grafting, orthodontics, psychosocial guidance, dentistry, osteotomy versus distraction, and rhinoplasty. The final CPGs were obtained after review by all stakeholders and allow cleft teams to base their treatment on current knowledge. With high-quality evidence lacking, the need for additional high-quality studies has become apparent.
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Affiliation(s)
- Aebele B. Mink van der Molen
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.M.v.B.); (L.N.A.v.A.)
- Correspondence: ; Tel.: +31-88-7554-004
| | - Johanna M. M. van Breugel
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.M.v.B.); (L.N.A.v.A.)
| | - Nard G. Janssen
- Department Maxillo Facial Surgery and Dentistry, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (N.G.J.); (D.B.)
| | - Ronald J. C. Admiraal
- Department of Oto-Rhino-Laryngology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Leon N. A. van Adrichem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (J.M.M.v.B.); (L.N.A.v.A.)
| | | | - Dirk Bittermann
- Department Maxillo Facial Surgery and Dentistry, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (N.G.J.); (D.B.)
| | | | - Pieter H. Broos
- Knowledge Institute of the Federation of Medical Specialists, 3528 BL Utrecht, The Netherlands; (P.H.B.); (A.L.J.K.)
| | | | | | - Andrea L. J. Kortlever
- Knowledge Institute of the Federation of Medical Specialists, 3528 BL Utrecht, The Netherlands; (P.H.B.); (A.L.J.K.)
| | - Chantal M. Mouës-Vink
- Department of Plastic and Reconstructive Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands;
| | | | | | - Christl Vermeij-Keers
- Dutch Association for Cleft Palate and Craniofacial Anomalies, 3643 AE Mijdrecht, The Netherlands;
| | - Hester de Wilde
- Department of Speech Therapy, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, CH-3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Jakarta 10430, Indonesia
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Borre ED, Diab MM, Ayer A, Zhang G, Emmett SD, Tucci DL, Wilson BS, Kaalund K, Ogbuoji O, Sanders GD. Evidence gaps in economic analyses of hearing healthcare: A systematic review. EClinicalMedicine 2021; 35:100872. [PMID: 34027332 PMCID: PMC8129894 DOI: 10.1016/j.eclinm.2021.100872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hearing loss is a common and costly medical condition. This systematic review sought to identify evidence gaps in published model-based economic analyses addressing hearing loss to inform model development for an ongoing Lancet Commission. METHODS We searched the published literature through 14 June 2020 and our inclusion criteria included decision model-based cost-effectiveness analyses that addressed diagnosis, treatment, or prevention of hearing loss. Two investigators screened articles for inclusion at the title, abstract, and full-text levels. Data were abstracted and the studies were assessed for the qualities of model structure, data assumptions, and reporting using a previously published quality scale. FINDINGS Of 1437 articles identified by our search, 117 unique studies met the inclusion criteria. Most of these model-based analyses were set in high-income countries (n = 96, 82%). The evaluated interventions were hearing screening (n = 35, 30%), cochlear implantation (n = 34, 29%), hearing aid use (n = 28, 24%), vaccination (n = 22, 19%), and other interventions (n = 29, 25%); some studies included multiple interventions. Eighty-six studies reported the main outcome in quality-adjusted or disability-adjusted life-years, 24 of which derived their own utility values. The majority of the studies used decision tree (n = 72, 62%) or Markov (n = 41, 35%) models. Forty-one studies (35%) incorporated indirect economic effects. The median quality rating was 92/100 (IQR:72-100). INTERPRETATION The review identified a large body of literature exploring the economic efficiency of hearing healthcare interventions. However, gaps in evidence remain in evaluation of hearing healthcare in low- and middle-income countries, as well as in investigating interventions across the lifespan. Additionally, considerable uncertainty remains around productivity benefits of hearing healthcare interventions as well as utility values for hearing-assisted health states. Future economic evaluations could address these limitations. FUNDING NCATS 3UL1-TR002553-03S3.
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Affiliation(s)
- Ethan D. Borre
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Mohamed M. Diab
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Austin Ayer
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Gloria Zhang
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Susan D. Emmett
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Debara L. Tucci
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, United States
| | - Blake S. Wilson
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
- Department of Electrical & Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Kamaria Kaalund
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Osondu Ogbuoji
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham NC, United States
| | - Gillian D. Sanders
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke University Clinical Research Institute, Duke University School of Medicine, Durham NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Corresponding author at: Gillian Sanders Schmidler, PhD, Duke-Robert J. Margolis, MD, Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC 27708-0120.
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Francis NA, Waldron CA, Cannings-John R, Thomas-Jones E, Winfield T, Shepherd V, Harris D, Hood K, Fitzsimmons D, Roberts A, Powell CV, Gal M, Jones S, Butler CC. Oral steroids for hearing loss associated with otitis media with effusion in children aged 2-8 years: the OSTRICH RCT. Health Technol Assess 2019; 22:1-114. [PMID: 30407151 DOI: 10.3310/hta22610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Children with hearing loss associated with otitis media with effusion (OME) are commonly managed through surgical intervention, hearing aids or watchful waiting. A safe, inexpensive, effective medical treatment would enhance treatment options. Small, poorly conducted trials have found a short-term benefit from oral steroids. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a 7-day course of oral steroids in improving hearing at 5 weeks in children with persistent OME symptoms and current bilateral OME and hearing loss demonstrated by audiometry. DESIGN Double-blind, individually randomised, placebo-controlled trial. SETTING Ear, nose and throat outpatient or paediatric audiology and audiovestibular medicine clinics in Wales and England. PARTICIPANTS Children aged 2-8 years, with symptoms of hearing loss attributable to OME for at least 3 months, a diagnosis of bilateral OME made on the day of recruitment and audiometry-confirmed hearing loss. INTERVENTIONS A 7-day course of oral soluble prednisolone, as a single daily dose of 20 mg for children aged 2-5 years or 30 mg for 6- to 8-year-olds, or matched placebo. MAIN OUTCOME MEASURES Acceptable hearing at 5 weeks from randomisation. Secondary outcomes comprised acceptable hearing at 6 and 12 months, tympanometry, otoscopic findings, health-care consultations related to OME and other resource use, proportion of children who had ventilation tube (grommet) surgery at 6 and 12 months, adverse effects, symptoms, functional health status, health-related quality of life, short- and longer-term cost-effectiveness. RESULTS A total of 389 children were randomised. Satisfactory hearing at 5 weeks was achieved by 39.9% and 32.8% in the oral steroid and placebo groups, respectively (absolute difference of 7.1%, 95% confidence interval -2.8% to 16.8%; number needed to treat = 14). This difference was not statistically significant. The secondary outcomes were consistent with the picture of a small or no benefit, and we found no subgroups that achieved a meaningful benefit from oral steroids. The economic analysis showed that treatment with oral steroids was more expensive and accrued fewer quality-adjusted life-years than treatment as usual. However, the differences were small and not statistically significant, and the sensitivity analyses demonstrated large variation in the results. CONCLUSIONS OME in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. Discussions about watchful waiting and other interventions will be enhanced by this evidence. The findings of this study suggest that any benefit from a short course of oral steroids for OME is likely to be small and of questionable clinical significance, and that the treatment is unlikely to be cost-effective and, therefore, their use cannot be recommended. FUTURE WORK Studies exploring optimal approaches to sharing natural history data and enhancing shared decision-making are needed for this condition. TRIAL REGISTRATION Current Controlled Trials ISRCTN49798431 and EudraCT 2012-005123-32. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 61. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nick A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Thomas Winfield
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Amanda Roberts
- Cardiff & Vale University Health Board, Child Health Directorate, St David's Children Centre, Cardiff, UK
| | - Colin Ve Powell
- Department of General Paediatrics, Children's Hospital for Wales, Cardiff, UK
| | - Micaela Gal
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah Jones
- Involving People Network, Health and Care Research Wales, Cardiff, UK
| | - Christopher C Butler
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Karanth TK, Whittemore KR. Middle-ear disease in children with cleft palate. Auris Nasus Larynx 2018; 45:1143-1151. [DOI: 10.1016/j.anl.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
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Schilder AGM, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg 2017; 156:S88-S105. [PMID: 28372534 DOI: 10.1177/0194599816633697] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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Affiliation(s)
- Anne G M Schilder
- 1 evidENT, Ear Institute, University College London, London, United Kingdom.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tal Marom
- 3 Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Mahmood F Bhutta
- 4 Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Margaretha L Casselbrant
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harvey Coates
- 6 Department of Otolaryngology, School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia
| | - Marie Gisselsson-Solén
- 7 Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Amanda J Hall
- 8 University Hospitals Bristol NHS Foundation Trust and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Paola Marchisio
- 9 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aino Ruohola
- 10 Department of Pediatrics, University of Turku, Turku, Finland
| | - Roderick P Venekamp
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen M Mandel
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Kuşcu O, Günaydın RÖ, İcen M, Ergün O, Kulak Kayikci ME, Yılmaz T, Özgür FF, Akyol MU. The effect of early routine grommet insertion on management of otitis media with effusion in children with cleft palate. J Craniomaxillofac Surg 2015; 43:2112-5. [PMID: 26545930 DOI: 10.1016/j.jcms.2015.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/07/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim of the study is to compare long term otoscopic and audiological findings of cleft palate patients with or without early grommet insertion. METHODS Cleft palate patients followed-up in Hacettepe University between 2008 and 2013 were included in the study. Age, gender, cleft types and palate surgery data, grommet tube insertion history and otological - audiological evaluations of the patients were recorded. Patients were evaluated in three groups according to grommet insertion history: A-early routine grommet insertion, B-grommet insertion during follow-up, C-no grommet insertion. Otological and audiological findings were compared. RESULTS There were 154 patients in the study, with a median age of 7.7 years. There were 67 patients in group A (43.5%), 22 patients in group B (14.3%) and 65 patients in group C (42.2%). OME was identified significantly higher in group A and normal otoscopic examination findings were higher in group C. Complications showed a higher rate than other otoscopic findings in group B patients. There was no significant difference for any frequencies in between the groups in terms of mean air-bone gap (ABG) values. There were 20 grade I, 25 grade II, 77 grade III and 32 grade IV patients in the study according to the Veau classification. CONCLUSION Prophylactic grommet insertion may not be applied as some cleft palate patients with no OME. Wait and see protocol can be recommended for these patients, and they should be followed-up up closely to avoid complications. If the effusion does not recover or tympanic membrane changes occur in follow-up, grommet insertion should be considered.
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Affiliation(s)
- Oğuz Kuşcu
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
| | | | - Mehtap İcen
- Hacettepe University, Department of Otorhinolaryngology, Audiology and Speech Pathology Unit, Ankara, Turkey.
| | - Onur Ergün
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
| | - Mavis Emel Kulak Kayikci
- Hacettepe University, Department of Otorhinolaryngology, Audiology and Speech Pathology Unit, Ankara, Turkey.
| | - Taner Yılmaz
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
| | - Fatma Figen Özgür
- Department of Plastic and Reconstructive Surgery, Hacettepe University Medical School, Ankara, Turkey.
| | - Mehmet Umut Akyol
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
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