1
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Stanton E, Kondra K, Brahme I, Lasky S, Munabi NCO, Jimenez C, Jacob L, Urata MM, Hammoudeh JA, Magee WP. Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care. Cleft Palate Craniofac J 2023; 60:430-445. [PMID: 35044261 DOI: 10.1177/10556656211067901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To understand the indication for and the effects of early ventilation tube insertion (VTI) on hearing and speech for patients with cleft lip and/or palate (CLP). DESIGN We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-guided systematic review of relevant literature. SETTING Setting varied by geographical location and level of clinical care across studies. PATIENTS, PARTICIPANTS Patients with CLP who underwent VTI were included. INTERVENTIONS No interventions were performed. MAIN OUTCOME MEASURE(S) Primary outcome measures were hearing and speech following VTI. Secondary outcome measures were tube-related and middle ear complications. Early VTI occurred before or at time of palatoplasty while late VTI occurred after palatoplasty. RESULTS Twenty-three articles met inclusion criteria. Articles varied among study design, outcome measures, sample size, follow-up, and quality. Few studies demonstrated support for early VTI. Many studies reported no difference in hearing or speech between early and late VTI. Others reported worse outcomes, greater likelihood of complications, or needing repeat VTI following early tympanostomy placement. Several studies had significant limitations, including confounding variables, small sample size, or not reporting on our primary outcome. CONCLUSIONS No consistency was found regarding which patients would benefit most from early VTI. Given the aforementioned variability and sub-optimal methodologies, additional studies are warranted to provide stronger evidence regarding VTI timing in cleft care.
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Affiliation(s)
- Eloise Stanton
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | - Katelyn Kondra
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | | | - Sasha Lasky
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Christian Jimenez
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | - Laya Jacob
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
| | - Mark M Urata
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Jeffrey A Hammoudeh
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA.,University of Southern California, Los Angeles, CA, USA
| | - William P Magee
- 5150Children's Hospital Los Angeles, Los Angeles, CA, USA.,Keck School of Medicine, Los Angeles, CA, USA
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2
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Joos U, Markus AF, Schuon R. Functional cleft palate surgery. J Oral Biol Craniofac Res 2023; 13:290-298. [PMID: 36911175 PMCID: PMC9996444 DOI: 10.1016/j.jobcr.2023.02.003] [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: 12/06/2022] [Accepted: 02/06/2023] [Indexed: 03/05/2023] Open
Abstract
Cleft lip and palate (CLP) as a dislocation malformation confronts parents with a malformation of their child that could not be more central and visible: the face. In addition to the stigmatizing appearance, however, in cases of a CLP, food intake, physiological breathing, speech and hearing are also affected. In this paper, the principles of morphofunctional surgical reconstruction of the cleft palate are presented. With the closure of the palate, and restoration of the anatomy, a situation is achieved enabling nasal respiration, normal or near normal speech without nasality, improved ventilation of the middle ear, normal oral functions with coordinated interaction of the tongue with the hard and soft palate important for the oral and pharyngeal phases of feeding. With the establishment of physiological function, in the early phases of the infant and toddler, these activities initiate essential growth stimulation, leading to normalisation of facial and cranial growth. If these functional considerations are disregarded during primary closure, lifelong impairment of one or more of the abovementioned processes often follows. In many cases, despite secondary surgery and revision, it might not be possible to correct and achieve the best possible outcomes, especially if critical stages of development and growth have been missed or there has been significant tissue loss due to resection of existing tissue while primary surgery. This paper describes functional surgical methods and reviews long term, over many decades, results of children with cleft palate.
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Affiliation(s)
- Ulrich Joos
- International Medical College, University Duisburg, Essen, Germany
| | - Anthony F. Markus
- Emeritus Consultant Maxillofacial Surgeon, Poole Hospital, United Kingdom
| | - Robert Schuon
- Department of Otorhinolaryngology, Hannover Medical School, Germany
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3
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Pasricha A, Mago V, Sarma H, Jayaprakash P, Vathulya M, Chattopadhyay D. Hearing-related problems in children with cleft palate: A single-center cross-sectional study in the sub-Himalayan population. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2023. [DOI: 10.4103/jclpca.jclpca_12_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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Hashemi Hosseinabad H, Washington KN, Boyce SE, Silbert N, Kummer AW. Assessment of Intelligibility in Children with Velopharyngeal Insufficiency: The Relationship between Intelligibility in Context Scale and Experimental Measures. Folia Phoniatr Logop 2021; 74:17-28. [PMID: 34107483 DOI: 10.1159/000516537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the clinical application of the Intelligibility in Context Scale (ICS) instrument in children with velopharyngeal insufficiency (VPI). This study investigated the relationship between clinical speech outcomes and parental reports of speech intelligibility across various communicative partners. METHODS The ICS was completed by the parents of 20 English-speaking children aged 4-12 years diagnosed with VPI. The parents were asked to rate their children's speech intelligibility across communication partners using a 5-point scale. Clinical metrics obtained using standard clinical transcription on the Picture-Cued SNAP-R Test were: (1) percentage of consonants correct (PCC), (2) percentage of vowels correct (PVC), and (3) percentage of phonemes correct (PPC). Nasalance from nasometer data was included as an indirect measure of nasality. Intelligibility scores obtained from naive listener's transcriptions and speech-language pathologists' (SLP) ratings were compared with the ICS results. RESULT Greater PCC, PPC, PVC, and transcription-based intelligibility values were significantly associated with higher ICS values, respectively (r[20] = 0.84, 0.82, 0.51, and 0.70, respectively; p < 0.05 in all cases). There was a negative and significant correlation between ICS mean scores and SLP ratings of intelligibility (r = -0.74; p < 0.001). There was no significant correlation between ICS values and nasalance scores (r[20] = -0.28; p = 0.22). CONCLUSION The high correlations obtained between the ICS with PCC and PPC measures indicate that articulation accuracy has had a great impact on parents' decision-making regarding intelligibility in this population. Significant agreement among ICS scores with naive listener transcriptions and clinical ratings supports use of the ICS in practice.
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Affiliation(s)
- Hedieh Hashemi Hosseinabad
- Department of Communication Sciences and Disorders, College of Health Science and Public Health, Eastern Washington University, Spokane, Washington, USA
| | - Karla N Washington
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Suzanne E Boyce
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Noah Silbert
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ann W Kummer
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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5
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Sullivan ZC, Van Eeden S, McMahon S, Edwards Z, Flannigan N, Seshu M, Dominguez-Gonzalez S. Identifying associations between dental arch relationship scores, relative deprivation and other cleft audit outcomes. Part 1. Orthod Craniofac Res 2021; 25:82-95. [PMID: 33998764 DOI: 10.1111/ocr.12495] [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: 11/28/2020] [Revised: 04/05/2021] [Accepted: 04/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess whether dental arch relationship scores are associated with speech, audiological and psychology outcomes in patients with complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). SETTING AND SAMPLE POPULATION One hundred 5-year-old children with non-syndromic complete UCLP and forty-two 5-year-olds with non-syndromic complete BCLP from the United Kingdom. MATERIAL AND METHODS Data were collected from five-year audit clinics for dental arch relationships, speech, hearing and psychology outcomes. Associations were assessed between ordinal prognostic covariates and the dental arch relationship outcome using a Cochrane-Armitage test for trend and comparisons with binary prognostic covariates using chi-square/Fisher's exact test. This was extended to assess associations between five-year audit outcomes and a measure of deprivation. RESULTS There was no evidence of associations between dental arch relationships and outcomes for audiology and speech. Individual domain analysis of the psychology outcomes within the UCLP cohort reported a poor outcome for Pro-social score to be associated with a poor 5-year-old index score (P = .018). For the BCLP sample, a good outcome for the BCLP Deciduous Dentition Yardstick was associated with a good conduct score (P = .01). CONCLUSION There was no association with the 5-year-old index/BCLP Deciduous Dentition Yardstick score and outcomes reported for audiology and speech. For the UCLP and BCLP cohorts, a poor dental arch relationship outcome may be associated with issues with some aspects of psychological well-being, associated with peer interactions and conduct. The deprivation index of samples had no association with the outcomes assessed.
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Affiliation(s)
| | | | | | - Zoe Edwards
- Alder Hey Hospital Children's Hospital, Liverpool, UK
| | - Norah Flannigan
- Orthodontic Department, Liverpool University Dental Hospital, Liverpool, UK
| | - Madhavi Seshu
- Alder Hey Hospital Children's Hospital, Liverpool, UK
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6
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Téblick S, Ruymaekers M, Van de Casteele E, Nadjmi N. Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review. J Oral Maxillofac Surg 2019; 77:405.e1-405.e15. [DOI: 10.1016/j.joms.2018.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 12/01/2022]
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Otitis media with effusion in Nigerian children with cleft palate: incidence and risk factors. Br J Oral Maxillofac Surg 2019; 57:36-40. [DOI: 10.1016/j.bjoms.2018.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022]
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8
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Kim E, Kanack MD, Dang-Vu MD, Carvalho D, Jones MC, Gosman AA. Evaluation of Ventilation Tube Placement and Long-term Audiologic Outcome in Children with Cleft Palate. Cleft Palate Craniofac J 2017; 54:650-655. [DOI: 10.1597/15-349] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The purpose of this study was to assess the effect of ventilation tube (VT) placement on long-term hearing outcomes in children with cleft palate. Study Design Case series with chart review. Setting Genetic and dysmorphology database at Rady Children's Hospital–San Diego (RCHSD). Patients Children with cleft palate diagnosis who underwent surgery at RCHSD between 1995 and 2002. Main Outcome Measure The primary outcome studied was hearing acuity at 10 years of age. Independent variables studied included gender, age at palate repair and first VT placement, total number of VTs, number of complications, and presence of tympanic membrane perforation. Results An increased number of tubes was associated with a greater incidence of hearing loss at age 10, even after adjusting for total number of otologic complications. The timing of initial tube placement did not have a significant effect on long-term hearing outcome in this study. Conclusions While children with worse middle ear disease are more likely to receive more tubes and have long-term conductive hearing loss as a result of ear disease, the results of this study suggest that multiple tube placements may not contribute to improved long-term hearing outcomes. Further research focusing on long-term outcomes is needed to establish patient-centered criteria guiding decision making for ventilation tube placement in children with cleft palate.
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Affiliation(s)
- Elissa Kim
- University of California, San Diego School of Medicine, La Jolla, California
| | - Melissa D. Kanack
- Department of Plastic Surgery, University of California, Irvine, Orange, California
| | - Milan D. Dang-Vu
- Branch Health Clinic Iwakuni-Japan, Medical Corps, United States Navy
| | - Daniela Carvalho
- Department of Surgery, Rady Children's Hospital–San Diego, San Diego, California, Division of Otolaryngology/Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California
| | - Marilyn C. Jones
- Department of Pediatrics, University of California, San Diego, San Diego, California, Genetics and Dysmorphology, Rady Children's Hospital–San Diego, San Diego, California
| | - Amanda A. Gosman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, California, Rady Children's Hospital–San Diego, San Diego, California
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9
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Bruce I, Harman N, Williamson P, Tierney S, Callery P, Mohiuddin S, Payne K, Fenwick E, Kirkham J, O'Brien K. The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation. Health Technol Assess 2016; 19:1-374. [PMID: 26321161 DOI: 10.3310/hta19680] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate. OBJECTIVES To identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies. DESIGN The management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP. SETTING The survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients' homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting. PARTICIPANTS Clinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association. RESULTS The clinician survey revealed that care was predominantly delivered via a 'hub-and-spoke' model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research. CONCLUSIONS There exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered. FUNDING The National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
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Affiliation(s)
- Iain Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children's Hospital, Manchester, UK
| | - Nicola Harman
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
| | - Paula Williamson
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK.,Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephanie Tierney
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Jamie Kirkham
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
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10
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Alencar TRR, Marques IL, Bertucci A, Prado-Oliveira R. Neurological Development of Children With Isolated Robin Sequence Treated With Nasopharyngeal Intubation in Early Infancy. Cleft Palate Craniofac J 2016; 54:256-261. [PMID: 27043650 DOI: 10.1597/14-228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The study assessed the neurodevelopment of children with isolated Robin sequence (IRS) and evaluated if children treated exclusively with nasopharyngeal intubation (NPI) present delay in neurological development. The prospective and cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Children with IRS were divided into two groups according to the type of treatment in early infancy: 38 were treated with NPI (more severe cases) and 24 with postural treatment (less severe cases). Regarding interventions, children were assessed at 2 to 6 years of age using the Denver II Developmental Screening Test (Denver II) and Neurological Evolutionary Examination (NEE). According to Denver II, 73.7% in the NPI group and 79.2% in the postural group presented normal development. This result was similar to the results of different studies in the literature with typical population. Considering all areas of development, there were no significant differences in Denver II between the NPI and postural groups (P = .854). In the NPI group, 89.5% of children and 87.5% in the postural group presented normal development in NEE. Language was the most affected area, as 18.4% and 20.8% of children in NPI and postural group, respectively, presented risk for delay in the Denver II. The increased risk for delay in language area was probably due to anatomical conditions of the muscles involved in speech, and to hearing oscillations, as 47.4% in NPI group and 58.3% in postural group underwent myringotomy. IRS treated with NPI had neurological development similar to those in less severe cases. Children treated exclusively with NPI did not present delay in neurological development.
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Smallridge J, Hall AJ, Chorbachi R, Parfect V, Persson M, Ireland AJ, Wills AK, Ness AR, Sandy JR. Functional outcomes in the Cleft Care UK study--Part 3: oral health and audiology. Orthod Craniofac Res 2015; 18 Suppl 2:25-35. [PMID: 26567853 PMCID: PMC4950029 DOI: 10.1111/ocr.12110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. SETTING AND SAMPLE POPULATION Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. MATERIALS AND METHODS Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. RESULTS Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. CONCLUSIONS Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented.
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Affiliation(s)
- J Smallridge
- South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK
- Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK
| | - A J Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Chorbachi
- North Thames Cleft Centre, Great Ormond Street Hospital for Children and Broomfield Hospital, London, UK
| | - V Parfect
- East of England Cleft Network, Audiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A R Ness
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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12
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Harman NL, Bruce IA, Kirkham JJ, Tierney S, Callery P, O'Brien K, Bennett AMD, Chorbachi R, Hall PN, Harding-Bell A, Parfect VH, Rumsey N, Sell D, Sharma R, Williamson PR. The Importance of Integration of Stakeholder Views in Core Outcome Set Development: Otitis Media with Effusion in Children with Cleft Palate. PLoS One 2015; 10:e0129514. [PMID: 26115172 PMCID: PMC4483230 DOI: 10.1371/journal.pone.0129514] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022] Open
Abstract
Background Approximately 75% of children with cleft palate (CP) have Otitis Media with Effusion (OME) histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS). Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited. Methods and Findings A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT) surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of “consensus in” to form the recommended COS: hearing; chronic otitis media (COM); OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM); cholesteatoma; side effects of treatment; listening skills; otalgia. Conclusions We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals, parents and children.
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Affiliation(s)
- Nicola L. Harman
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Iain A. Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Jamie J. Kirkham
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Stephanie Tierney
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Manchester, United Kingdom
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, United Kingdom
| | | | - Raouf Chorbachi
- North Thames Cleft Service and the Department of Audiological Medicine/ Audiology/Cochlear implants. Great Ormond Street Hospital for Children, London, United Kingdom
| | - Per N. Hall
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Anne Harding-Bell
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Victoria H. Parfect
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, Department of Health & Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Debbie Sell
- North Thames Cleft Service, Speech and Language Therapy, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ravi Sharma
- North West, Isle of Man and North Wales Cleft Lip and Palate Network, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
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13
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Kuo CL, Tsao YH, Cheng HM, Lien CF, Hsu CH, Huang CY, Shiao AS. Grommets for otitis media with effusion in children with cleft palate: a systematic review. Pediatrics 2014; 134:983-94. [PMID: 25287451 DOI: 10.1542/peds.2014-0323] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE No consensus has yet been reached with regard to the link between otitis media with effusion (OME), hearing loss, and language development in children with cleft palate. The objective of this study was to address the effectiveness of ventilation tube insertion (VTI) for OME in children with cleft palate. METHODS A dual review process was used to assess eligible studies drawn from PubMed, Medline via Ovid, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and reference lists between 1948 and November 2013. Potentially relevant papers were selected according to the full text of the articles. Relevant data were extracted onto a data extraction sheet. RESULTS Nine high- or moderate-quality cohort studies were included in this study. VTI was administered in 38% to 53% of the OME cases, and more severe cases appeared more likely to undergo VTI. Compared with conservative forms of management (eg, watchful waiting), VTI has been shown to be beneficial to the recovery of hearing in children with cleft palate and OME. A growing body of evidence demonstrates the benefits of VTI in the development of speech and language in children with cleft palate and OME. These children face a higher risk of complications than those undergoing conservative treatments, the most common of which are eardrum retraction and tympanosclerosis, with an incidence of ∼ 11% to 37%. CONCLUSIONS This review provides evidence-based information related to the selection of treatment for OME in children with cleft palate. Additional randomized controlled trials are required to obtain bias-resistant evidence capable of reliably guiding treatment decisions. The conclusions in this review are based on underpowered cohort studies and very-low-strength evidence.
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Affiliation(s)
- Chin-Lung Kuo
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology, Institute of Brain Science, and Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China; Department of Otolaryngology, National Defense Medical Center, Taipei, Taiwan, Republic of China; and
| | - Yuan-Heng Tsao
- Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China; Department of Otolaryngology, National Defense Medical Center, Taipei, Taiwan, Republic of China; and
| | - Hao-Min Cheng
- Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
| | - Chiang-Feng Lien
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology
| | - Chyong-Hsin Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Chii-Yuan Huang
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology
| | - An-Suey Shiao
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology, Department of Otolaryngology, National Defense Medical Center, Taipei, Taiwan, Republic of China; and
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Early placement of ventilation tubes in cleft lip and palate patients: does palatal closure affect tube occlusion and short-term outcome? Int J Pediatr Otorhinolaryngol 2012; 76:1481-4. [PMID: 22796197 DOI: 10.1016/j.ijporl.2012.06.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/21/2012] [Accepted: 06/24/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Otitis media with effusion is almost universal in children with cleft palate due to the poor function of the Eustachian tube. Our study investigates the functioning of ventilation tubes placed at the time of primary cleft surgery (4 months of age) and at the time of secondary surgery (12 months of age). We compared two different surgical protocols: (Leg A) closure of the lip and soft palate at the age of 3-4 months (primary surgery) and closure of the hard palate at the age of 12 months (secondary surgery), and (Leg C) closure of the lip at the age of 3-4 months (primary surgery) and closure of the hard and soft palate at the age of 12 months (secondary surgery). METHODS A retrospective review of the medical records of 97 Finnish children with unilateral cleft lip and palate (UCLP) included in the Scandcleft study and randomized into two groups. RESULTS The majority (63%) of cleft (lip and) palate children benefit from early placement of ventilation tubes, and this group is even larger with early closure of the soft palate (86%; p=0.02). Closure of the soft palate at four months of age also reduces the frequency of OME in ears with the tube extruded or occluded, thus indicating better function of the Eustachian tube (p=0.02). CONCLUSIONS Early tympanostomy tube placement should be considered in children with cleft lip and palate, even prior to palatal closure.
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Palandi BBN, Guedes ZCF. Aspectos da fala de indivíduos com fissura palatina e labial, corrigida em diferentes idades. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: comparar indivíduos com fissura labiopalatina que realizaram correção cirúrgica em diferentes idades e verificar quais os fatores intervenientes mais importantes nas alterações da fala. MÉTODOS: a amostra é composta por 29 indivíduos que nasceram com fissura labiopalatina e foram submetidos à correção cirúrgica em diferentes idades, sem outros comprometimentos associados (neurológicos, físicos, psicológicos, etc). Estes indivíduos foram avaliados sem se levar em consideração a etiologia e o tipo de malformação encontrado. Sendo que 13 do sexo masculino e 16 do sexo feminino possuem idades variando de seis a 13 anos de idade. Os indivíduos são do ambulatório de Distúrbios da Comunicação Humana de uma Universidade Pública Federal e do ambulatório de Cirurgia Plástica de um Hospital Público que ainda não entraram em terapia fonoaudiológica. A fala, desses indivíduos, foi avaliada pelo Teste de Fonologia (capítulo 1 do ABFW, Teste de Linguagem Infantil), e por meio da nomeação foi analisada a fala dos indivíduos. A nomeação foi feita com figuras simples que foram mostradas a eles. RESULTADOS: os resultados do presente estudo quanto ao sexo e o tipo de fissura da amostra não apresentaram resultados estatisticamente significantes. Entretanto, a época tardia em que ocorreu a cirurgia reparadora interferiu de forma negativa para emissão de fala desses pacientes. CONCLUSÕES: com base nos resultados obtidos da análise da fala de indivíduos com fissura labiopalatina, pode-se concluir que um fator interveniente importante para a sua fala é a idade em que é realizada a cirurgia corretiva.
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Szabo C, Langevin K, Schoem S, Mabry K. Treatment of persistent middle ear effusion in cleft palate patients. Int J Pediatr Otorhinolaryngol 2010; 74:874-7. [PMID: 20537733 DOI: 10.1016/j.ijporl.2010.04.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 04/22/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The goals of the research project are to learn how to individualize otologic care for cleft palate patients and to be able to counsel families of children with cleft palate on the benefit of tympanostomy tubes, hearing issues and risks of multiple sets of tubes. METHODS The study is a retrospective chart review. Patients with a cleft palate with or without a cleft lip born between 1 January 2000 and 31 December 2005 referred to the Connecticut Children's Medical Center Craniofacial Department were included in the study. The patients were offered individualized ear surgery (PE tube placement) only if persistent middle ear fluid was present for over 3 months with a conductive hearing impairment. The primary outcome measures included the newborn hearing screening results, number of ear tube surgeries, and complications of PE tube insertion. RESULTS There were 86 patients with cleft palate spectrum with or without cleft lip (45 females and 41 males). Twelve had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive. By 5 years old, 84 (98%) patients received at least one set of ear tubes for persistent middle ear fluid with conductive hearing impairment, while 2 received no tubes (2%). Of those who received ear tubes, the range was 1-6 with a mean of 1.7. Twelve patients (14%) had tympanosclerosis. Eight patients (9%) had eardrum perforation. One patient had myringoincudopexy. Of the 86 patients, 12 had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive. CONCLUSIONS (1) The majority of children born with cleft palate do not have middle ear fluid at birth. (2) Most children with cleft palate will likely develop persistent middle ear fluid with conductive hearing loss. Risks of complications from ear tubes in cleft palate patients are few and manageable using standard sized ear tubes.
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Affiliation(s)
- C Szabo
- Division of Otolaryngology, Connecticut Children's Medical Center, Hartford, CT 06106, United States
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Da Silva DP, Collares MVM, Da Costa SS. Effects of Velopharyngeal Dysfunction on Middle Ear of Repaired Cleft Palate Patients. Cleft Palate Craniofac J 2010; 47:225-33. [DOI: 10.1597/09-008.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Cleft palates are strongly associated with the development of otitis media due to the anatomic and functional defect of the soft palate musculature and the associated alterations of velopharyngeal muscle insertion on tubal cartilage, or even intrinsic alterations of the cartilage, which affects eustachian tube function. This study will assess velopharyngeal muscle adequacy after palatoplasty through videonasoendoscopy and verify if there is a correlation with otologic status. Design Transversal study. Setting Otorhinolaryngology and cleft palate outpatient service of the Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Patients Seventy-three patients with cleft palate or cleft lip and palate between the ages of 6 and 12 years who had already undergone palatoplasty. Interventions Videonasoendoscopy for evaluation of velopharyngeal function and videotoscopy to assess middle ear status. Main Outcome Measures Severity scale for videonasoendoscopic and videotoscopic findings. Results There was no significant correlation between the videonasoendoscopic and the videotoscopic scores in the population studied. Discussion and Conclusions Intrinsic defects of the eustachian tube cartilage and of the insertion of the velopharyngeal muscles seem to contribute to the evolution of otitis media in patients with cleft palate, in addition to the actual defect of the soft palate. There was no correlation between the severity of the otoscopic findings and the degree of velopharyngeal dysfunction.
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Affiliation(s)
- Daniela Preto Da Silva
- Universidade Federal do Rio Grande do Sul, Member of the Craniofacial Surgery Group of Hospital de Clinicas de Porto Alegre, Fellowship on Otology and Cochlear Implants of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcus Vinicius Martins Collares
- Craniomaxillofacial Surgery, Universidade Federal do Rio Grande do Sul, Head of the Craniofacial Surgery Group of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Sady Selaimen Da Costa
- Otorhinolaryngology, Universidade Federal do Rio Grande do Sul, Head of the Chronic Otitis Media Center of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Zambonato TCDF, Feniman MR, Blasca WQ, Lauris JRP, Maximino LP. Profile of patients with cleft palate fitted with hearing AIDS. Braz J Otorhinolaryngol 2010; 75:888-92. [PMID: 20209293 PMCID: PMC9446106 DOI: 10.1016/s1808-8694(15)30555-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 10/05/2009] [Indexed: 11/13/2022] Open
Abstract
Cleft palates cause alterations in palate and lip structures, and it may also cause hearing loss because of recurrent otitis media. The appropriate treatment is controversial. It may include the prescription of antibiotics and insertion of a ventilation tube, or even otorhinolaryngological and audiological assistance, and hearing rehabilitation, with the use of an individual sound amplifier aid (ISAA). Aim To characterize the profile of individuals with cleft palate and hearing loss, users of ISAA are assisted by the center of otorhinolaryngology and speech therapy of a hospital specialized in craniofacial anomalies and hearing impairment. Retrospective Study. Materials and Methods Retrospective analysis of 131 charts of patients with corrected cleft palate and hearing loss, fitted with ISAA by the center abovementioned. Results The sample (n=131) was characterized by a prevalence of females (53%), unilateral incisive transforaminal cleft (27%), presence of associated anomalies (51%), history of alterations of the middle ear (56%) and surgery intervention (56%). Conclusion The general profile of the individuals with cleft palate and hearing loss, fitted with ISAA, was characterized by the predominance of cleft lip and palate, positive history of middle ear alterations, surgery intervention and bilateral sensorineural hearing loss.
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Rullo R, Di Maggio D, Festa VM, Mazzarella N. Speech assessment in cleft palate patients: a descriptive study. Int J Pediatr Otorhinolaryngol 2009; 73:641-4. [PMID: 19181392 DOI: 10.1016/j.ijporl.2008.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 12/12/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Speech disorders could affect the intelligibility, but also social competence and emotional development of a cleft-palate child. In this study, we proposed to examine the phono-articulatory defects of a group of surgically treated cleft palate patients, relatively to the familial social background, and children ability of self-controlling during spontaneous language. METHODS Sixty-eight children (22 males and 46 females) mean age 6.87 years, affected by a non-syndromic isolated cleft of the palate underwent to the same surgical protocol. Linguistic level was evaluated using the speech assessment protocol of Accordi and colleagues that focuses on intelligibility, nasality, nasal air escape, pharyngeal friction, and glottal stop. Each of these parameters is evaluated on a four-point scale, ranging from 0 to 3. Spearman rank order correlation was used to detect significant association between analyzed parameters; also the patient social background was considered for statistical analysis. RESULTS The 5.88% of the sample had a negative result, with a severe to moderate degree of nasality and nasal air escape, presence of pharyngeal friction and glottal stop and, obviously a systematic compromising of the intelligibility. Also grimace was evident. The 38.23% of the sample showed an acceptable phonological outline; nasality and nasal air escape were mild, and the intelligibility resulted normal. Thirty-eight children (55.88%) showed a perfectly normal speech. Statistical analysis (Spearman rank order correlation) revealed a positive correlation between the severity of nasality and nasal air escape and the patient social contest of life (p</=0.05); moreover, there was a positive correlation between nasality and nasal air escape with the final intelligibility (p<or=0.05), and between the intelligibility and the patient social contest of life. CONCLUSION Phonetic and phonological development in cleft child are not only due to the surgical strategies and the surgeon experience, but also influenced by the willingness to collaborate of the patient and especially of the parents, the timeliness of the logopaedic intervention, and by inborn capabilities of the child to control the emission of the air from nasal and oral cavities.
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Affiliation(s)
- R Rullo
- Department of Odontostomatological, Orthodontical and Surgical Sciences, Dental Clinic, Second University of Naples, Italy
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:569-72. [PMID: 19005328 DOI: 10.1097/moo.0b013e32831cf1a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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