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Aboelsayed KMS, Abdel Razek MK, Assal S, Habib AMA, Negm RA. Effect of prosthetic management and its timing on otological and audiological outcomes in infants with cleft lip and palate: A clinical trial. J Prosthodont 2024; 33:533-540. [PMID: 38689452 DOI: 10.1111/jopr.13861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE To evaluate how prosthetic management affects the otological and audiological state of infants with cleft lip and palate by preventing or treating otitis media (OM). MATERIALS AND METHODS Thirty infants with cleft lip and palate (L/P) were assigned to three equal groups according to the age of prosthetic intervention; Group I: immediately after birth, Group II: 2 months old, Group III: 5 months old. Assessment of middle ear function by tympanometry and hearing quality by auditory brainstem response (ABR) under natural sleep was conducted before and after prosthetic treatment every month till 10 months of age. Data from the study groups were compared. RESULTS No statistically significant differences were found between Gp I and Gp II in the 2nd, 3rd, and 4th months for right and left ears (p > 0.05). In the 5th month, statistically significant differences between the three groups were found in tympanometry for right (p = 0.011) and left (p = 0.024) ears also, in ABR for right (p = 0.007) and left (p = 0.011) ears. Tympanometric readings starting from the 6th till the 10th month showed no statistically significant differences between the three groups (p >0.05). The final ABR outcomes of the 10th month indicated statistically significant differences between the three groups for both ears (p = 0.027). CONCLUSIONS Early prosthetic care could delay the development of OM, so it could potentially improve the otological and audiological state in infants with cleft L/P. However, prosthetic treatment may not be able to completely prevent or eliminate middle ear disorders.
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Affiliation(s)
- Kamel M S Aboelsayed
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | | | - Samir Assal
- Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed M A Habib
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rana A Negm
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Aboelsayed KMS, Abdel Razek MKH, Assal S, Habib AMA, Negm RA. Effect of prosthetic management of congenital cleft lip and palate on the middle ear function of infants: A clinical trial. J Prosthet Dent 2024:S0022-3913(24)00199-9. [PMID: 38565440 DOI: 10.1016/j.prosdent.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
STATEMENT OF PROBLEM Infants with a cleft palate often experience middle ear disease, a condition of great significance, and early prosthetic management of these infants is essential. However, any correlation between prosthetic palatal obturation and middle ear function is unclear. PURPOSE The purpose of this clinical trial was to assess whether prosthetic palatal obturation with a feeding appliance prevented or improved middle ear problems in infants with a cleft lip and palate. MATERIAL AND METHODS Ten infants with congenital cleft lip and palate (20 ears) were referred to the Prosthodontics department immediately after birth. Assessment of the middle ear function by tympanometry as well as hearing quality by auditory brainstem response (ABR) was conducted before the prosthetic treatment (control readings). The middle ear function and hearing quality was followed up after the prosthetic treatment every month until surgical palatal closure (tenth month). The Friedman test was applied to compare data from the various study periods. When the results were significant, the Dunn post hoc test was conducted to compare the control first week readings with those of the later periods (α=.05 for all tests). RESULTS The preprosthetic readings of tympanometry in the first week were 90% Type A and 10% Type B for both right and left ears. Readings starting from the first to the fifth month revealed no statistically significant differences compared with the first week readings (P>.05). However, tympanometry readings starting from the sixth month (20% Type A and 80% Type B) until the tenth month (90% Type B and 10% Type C) for both ears represented a statistically significant difference compared with the first week readings (P≤.05). The preprosthetic readings of ABR in the first week showed that 90% of ears had normal hearing status and 10% had mild hearing loss. Readings starting from the first until the fifth month revealed no statistically significant differences compared with the first week readings (P>.05). However, ABR readings starting from the sixth month (20% normal hearing, 70% mild hearing loss, and 10% moderate hearing loss) until the tenth month (0% normal hearing, 80% mild hearing loss, and 20% moderate hearing loss) for both ears revealed a statistically significant difference compared with the first week readings (P≤.05). CONCLUSIONS Prosthetic palatal obturation with a feeding appliance plays a role in delaying rather than preventing the occurrence of otitis media with effusion in infants with a cleft lip and palate and could reduce the need for ventilation tubes.
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Affiliation(s)
- Kamel M S Aboelsayed
- Assistant Lecturer, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mahmoud K H Abdel Razek
- Professor, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Samir Assal
- Professor, Department of Otorhinolaryngology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed M A Habib
- Professor, Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rana A Negm
- Lecturer, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Poupore NS, Smaily H, Carroll WW, Pecha PP. Outcomes of Tympanoplasty After Cleft Palate Repair: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 169:1-11. [PMID: 35943797 PMCID: PMC10733860 DOI: 10.1177/01945998221118251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze graft success rates and hearing outcomes in patients with a history of cleft palate (CP) repair undergoing tympanoplasty. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS Per PRISMA guidelines, the databases were searched from date of inception through December 14, 2021. Studies of patients with previous CP repair who underwent tympanoplasty were included. Meta-analysis of proportions, continuous measures, odds ratios (ORs), and meta-regression were used to analyze graft success and hearing outcomes after tympanoplasty. RESULTS A total of 323 patients with CP repair and 1169 controls were included. The proportion of graft success was 86.7% (95% CI, 76.1%-94.5%) in patients with CP repair and 88.8% (95% CI, 76.9-96.8) in controls. There was no difference in odds of graft success between patients with CP repair and controls (OR, 1.0 [95% CI, 0.5-1.8]; P = .870). Age was not a significant moderator of graft success in patients with CP repair (r = 0.1 [95% CI, -0.2 to 0.3]; P = .689) or controls (r = -0.0 [95% CI, -0.1 to 0.1]; P = .952). Comparing mean differences between pre- and postoperative air-bone gap was not statistically significant in patients with CP repair and controls (0.2 dB [95% CI, -3.1 to 3.4]; P = .930). Odds of functional success (postoperative air-bone gap <20 dB) were not different between the groups (OR, 0.8 [95% CI, 0.5-1.4]; P = .450). CONCLUSION This meta-analysis does not endorse anatomic or functional differences between patients with CP repair and controls after tympanoplasty. However, there is a paucity of evidence for younger children. Further studies are warranted to elucidate specific risk factors for tympanoplasty outcomes in young patients with previous CP repair.
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Affiliation(s)
- Nicolas S. Poupore
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Hussein Smaily
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - William W. Carroll
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Hidaka H, Ito M, Ikeda R, Kamide Y, Kuroki H, Nakano A, Yoshida H, Takahashi H, Iino Y, Harabuchi Y, Kobayashi H. Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan - 2022 update. Auris Nasus Larynx 2022:S0385-8146(22)00232-2. [PMID: 36577619 DOI: 10.1016/j.anl.2022.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022]
Abstract
This is an update of the 2015 Guidelines developed by the Japan Otological Society and Oto-Rhino-Laryngeal Society of Japan defining otitis media with effusion (OME) in children (younger than 12 years old) and describing the disease rate, diagnosis, and method of examination. Recommended therapies that received consensus from the guideline committee were updated in consideration of current therapies used in Japan and based on available evidence. METHOD Regarding the treatment of OME in children, we developed Clinical Questions (CQs) and retrieved documents on each theme, including the definition, disease state, method of diagnosis, and medical treatment. In the previous guidelines, no retrieval expression was used to designate a period of time for literature retrieval. Conversely, a literature search of publications from March 2014 to May 2019 has been added to the JOS 2015 Guidelines. For publication of the CQs, we developed and assigned strengths to recommendations based on the collected evidence. RESULTS OME in children was classified into one group lacking the risk of developing chronic or intractable disease and another group at higher risk (e.g., children with Down syndrome, cleft palate), and recommendations for clinical management, including follow-up, is provided. Information regarding management of children with unilateral OME and intractable cases complicated by adhesive otitis media is also provided. CONCLUSION In clinical management of OME in children, the Japanese Clinical Practice Guidelines recommends management not only of complications of OME itself, such as effusion in the middle ear and pathologic changes in the tympanic membrane, but also pathologic changes in surrounding organs associated with infectious or inflammatory diseases.
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Affiliation(s)
- Hiroshi Hidaka
- Department of Otorhinolaryngology-Head and Neck Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.
| | - Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Children's Medical Center Tochigi, Jichi Medical University, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology-Head & Neck Surgery, Iwate Medical University, Japan
| | | | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | - Haruo Yoshida
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Haruo Takahashi
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Tokyo-Kita Medical Center, Japan
| | - Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, Japan
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Clinical characteristics of infants identified with a conductive hearing loss through universal newborn hearing screening: A population-based sample. Int J Pediatr Otorhinolaryngol 2022; 161:111268. [PMID: 35964490 DOI: 10.1016/j.ijporl.2022.111268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/31/2022] [Accepted: 07/31/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Universal Newborn Hearing Screening (UNHS) aims to identify infants born with a permanent hearing loss. However, many are also diagnosed with a conductive hearing loss (CHL) and are at subsequent risk for developmental delays. The aim of this study was to investigate the prevalence of CHL and determine which clinical characteristics collected at birth, predict CHL within UNHS. MATERIALS AND METHODS Retrospective analysis was conducted on all infants born between January 01, 2007 and December 31, 2018. During this period, 731,234 infants were screened, 9802 were direct referrals, and 1208 identified with a CHL. Chi squared analysis and logistic regression was conducted to determine CHL prevalence and identify which clinical characteristics predict CHL. RESULTS The prevalence of CHL was 12.32%. Following adjustments for collinearity, clinical characteristics that could predict CHL were: bilateral referrals/medical exclusions to screen (Odds ratio, OR 1.89; 95% CI: 1.65-2.1), ≥1 risk factor for hearing loss (OR 2.03; 95% CI: 1.76-2.34), pre-term birth (OR 1.82; 95% CI: 1.57-2.10), male (OR 1.21; 95% CI: 1.07-1.37), and Indigenous status: 'Aboriginal (not Torres Strait Islander)' (OR 1.27; 95% CI:1.03-1.57 and 'not stated' (OR 2.95; 95% CI: 2.02-4.30). CONCLUSION CHL within UNHS was highly prevalent, with six clinical characteristics that can predict that likelihood of an infant being diagnosed with a CHL. This data could be used to create alternative care pathways for infants with CHL, enabling early and targeted assessments, thereby reducing the risk of developmental delays for these infants.
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Iemura-Kashiwagi M, Okano T, Iwai N, Taniguchi M, Omori K. Prognosis of otitis media with effusion in pediatric patients with cleft palate during language-acquisition period treated by simultaneous tympanostomy tube placement with palatoplasty. Int J Pediatr Otorhinolaryngol 2022; 155:111071. [PMID: 35217270 DOI: 10.1016/j.ijporl.2022.111071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 01/30/2022] [Accepted: 02/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cleft palate (CP) in children is frequently complicated by otitis media with effusion (OME) due to Eustachian tube dysfunction. Although tympanostomy tube (TT) placement can be beneficial in the treatment of OME to prevent short-term hearing loss, there is no consensus regarding the indications for and timing of TT insertion. The present study was performed to define the safety and effectiveness of simultaneous TT placement with palatoplasty during the language-acquisition period. METHODS We retrospectively reviewed the medical charts of pediatric patients who underwent palatoplasty for CP in a tertiary medical center, Kyoto University Hospital, from June 2010 to October 2018. The TT retention time was estimated using the Kaplan-Meier method. The incidence of OME recurrence was compared among four Veau classification groups based on the patients' sex, type of CP, median TT retention time, and type of fluid. RESULTS Seventy-six subjects (150 ears) were enrolled in the study. The median follow-up duration was 48.7 months (range, 18.2-108.0 months) after the first TT placement. A first TT retention time of <20.1 months was a significant risk factor for OME recurrence. Subjects with maxillofacial anomaly complex and subjects with cleft lip and palate and an alveolar cleft showed a significantly higher OME recurrence rate than subjects with clefts only in the hard and/or soft palate. There was no significant difference in the occurrence of sequelae between subjects with only a single TT placement and subjects with more than one TT placement. CONCLUSIONS Based on the findings of the present study, it is reasonable to perform TT insertion at the same time as palatoplasty on patients who meet the indications. This technique may reduce the number of times the patient requires general anesthesia and maintain good middle ear condition during the period of language acquisition between 1 and 3 years of age.
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Affiliation(s)
- Maho Iemura-Kashiwagi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Otolaryngology-Head and Neck Surgery, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Takayuki Okano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Noriko Iwai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Iwai Clinic, Hirakata, Japan
| | - Mirei Taniguchi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Middle-ear effusion in children with cleft palate: congenital or acquired? The Journal of Laryngology & Otology 2022; 136:137-140. [PMID: 35001864 PMCID: PMC8889492 DOI: 10.1017/s0022215122000093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective Cleft palates are one of the most common congenital malformations. Because of the loss of Eustachian tube function, middle-ear ventilation is reduced. The aim of this study was to determine if middle-ear effusions were present at birth or at the three-month audiological evaluation. Method A total of 53 children with a cleft palate were included. Data review included the results of newborn hearing screening, microscopic findings, a tympanometry, a free field audiometry and intra-operative findings. Results A total of 58.4 per cent of patients had a median, 26.4 per cent had a bilateral, 11.3 per cent had a unilateral and 3.8 per cent had a limited soft palate cleft. Newborn hearing screening showed a pass in 83.1 per cent of newborns bilaterally. The first ear microscopy showed a bilateral middle-ear effusion in 90.6 per cent of cases. During cleft surgery, bilateral paracentesis was performed in all cases, and in 90.6 per cent middle-ear effusion was sucked out. Conclusion The majority of children with a cleft palate do not present with middle-ear effusion at birth. It develops within several days or weeks of life.
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Choffor‐Nchinda E, Bola Siafa A, Nansseu JR. Otitis media with effusion in Africa-prevalence and associated factors: A systematic review and meta-analysis. Laryngoscope Investig Otolaryngol 2020; 5:1205-1216. [PMID: 33364413 PMCID: PMC7752044 DOI: 10.1002/lio2.502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To estimate the overall and subgroup prevalence of otitis media with effusion (OME) in Africa, and identify setting-specific predictors in children and adults. METHODS PubMed, African Journals Online, African Index Medicus, Afrolib, SciELO, Embase, Scopus, Web of Science, The Cochrane Library, GreyLit and OpenGray were searched to identify relevant articles on OME in Africa, from inception to December 31st 2019. A random-effects model was used to pool outcome estimates. RESULTS Overall, 38 studies were included, with 27 in meta-analysis (40 331 participants). The overall prevalence of OME in Africa was 6% (95% CI: 5%-7%; I 2 = 97.5%, P < .001). The prevalence was 8% (95% CI: 7%-9%) in children and 2% (95% CI: 0.1%-3%) in adolescents/adults. North Africa had the highest prevalence (10%; 95% CI: 9%-13%), followed by West and Southern Africa (9%; 95% CI: 7%-10% and 9%; 95% CI: 6%-12% respectively), Central Africa (7%; 95% CI: 5%-10%) and East Africa (2%; 95% CI: 1%-3%). There was no major variability in prevalence over the last four decades. Cleft palate was the strongest predictor (OR: 5.2; 95% CI: 1.4-18.6, P = .02). Other significant associated factors were age, adenoid hypertrophy, allergic rhinitis in children, and type 2 diabetes mellitus, low CD4 count in adults. CONCLUSION OME prevalence was similar to that reported in other settings, notably high-income temperate countries. Health care providers should consider age, presence of cleft palate, adenoid hypertrophy and allergic rhinitis when assessing OME in children and deciding on a management plan. More research is required to confirm risk factors and evaluate treatment options. LEVEL OF EVIDENCE 3a.
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Affiliation(s)
- Emmanuel Choffor‐Nchinda
- Department of Surgery and Specialties, Faculty of Health SciencesUniversity of BueaBueaCameroon
- ENT Unit, Buea Regional HospitalBueaCameroon
| | - Antoine Bola Siafa
- Department of Otolaryngology – Head and Neck SurgeryYaoundé Teaching University HospitalYaoundeCameroon
- Department of Ophthalmology, Otolaryngology and Stomatology, Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé 1YaoundeCameroon
| | - Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé 1YaoundeCameroon
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Davis W, Cohen MA, Matthews MS. Change in Initial Tympanostomy Tube Placement Timing Yields Decreased Burden of Care Without Increased Complications in Patients With Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 57:1417-1421. [DOI: 10.1177/1055665620944759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective: To report a practice audit of the consequences of a change in protocol in the timing of placement of tympanostomy tubes in infants with cleft lip and palate. Participants: All children with a diagnosis of cleft lip and palate, treated between November 1998 and May 2006 under the old protocol, and between December 2012 and July 2016 under a new protocol. Under the old protocol, tympanostomy tubes were first inserted at the time of lip repair at around age 2 months. Under the new protocol, tympanostomy tubes were deferred until the time of palate repair around the age of 9 months. Children with syndromic diagnoses other than Stickler syndrome and Van der Woude syndrome, and children who failed newborn hearing screen were excluded. Main Outcome Measures: Incidence of otorrhea from birth to 6 months after palate repair and presence of hearing loss at ages 1 and 2. Results: Deferral of tympanostomy tubes until the time of palate repair decreases the burden of care due to otorrhea as compared to early tympanostomy tubes at the time of lip repair. There was no significant difference in the incidence of hearing thresholds at or below 15 dB at age 1 or 2. Conclusions: Placement of tympanostomy tubes at the time of palate repair balances the goals of minimizing the adverse effects from middle ear effusion and minimizing the burden of care on our patients and their families.
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Affiliation(s)
| | - Marilyn A. Cohen
- Cooper University Health Care, Cooper Regional Cleft Palate Program, NJ, USA
| | - Martha S. Matthews
- Department of Surgery, Cooper University Health Care and Cooper Medical School of Rowan University, NJ, USA
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McAndrew L. Parental Judgement of Hearing Loss in Infants With Cleft Palate. Cleft Palate Craniofac J 2020; 57:886-894. [PMID: 32013560 DOI: 10.1177/1055665619899743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate whether reported parental concern is supported by hearing assessment findings in children with cleft palate. To describe this population by examining the relationship between cleft type, middle ear status, and hearing loss. DESIGN Retrospective consecutive case note review. SETTING Tertiary institutional regional cleft center. PATIENTS Consecutive cases of 194 babies born with cleft palate and referred to the specialist center from January 2009 and December 2013. Following exclusions, data from 155 infants were included for analysis. INTERVENTIONS Documented parental concern in ear, nose and throat (ENT) and speech and language therapy case notes were compared to hearing assessment findings. Findings from otoscopic examination, tympanometry, and hearing assessment were analyzed with respect to cleft type. RESULTS Parental concern is not always accurately reflected by objective assessment particularly when no concern is reported. Analysis of the cohort examined suggests that cleft type is not related to middle ear findings or hearing. CONCLUSIONS It is helpful to be aware of parental concern and clinicians should consider that parental reports may not be accurately reflected by test results. As cleft type was not found to substantially influence middle ear status or hearing it is not recommended to adapt speech and language advice offered to families according to cleft type. Follow-up studies to increase participant numbers would support a statistical analysis.
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Affiliation(s)
- Lucy McAndrew
- Spires Cleft Centre Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
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Santos G, Ickow I, Job J, Brooker JE, Dvoracek LA, Rigby E, Shah N, Chen W, Branstetter B, Schuster LA. Cone-Beam Computed Tomography Incidental Findings in Individuals With Cleft Lip and Palate. Cleft Palate Craniofac J 2020; 57:404-411. [PMID: 31964169 DOI: 10.1177/1055665619897469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The use of cone-beam computed tomography (CBCT) is well-established in clinical practice. This study seeks to categorize and quantify the incidental finding (IF) rate on CBCT in patients with cleft lip and palate (CLP) prior to orthodontic or surgical treatment. METHODS This is systematic retrospective review of head and neck CBCTs in patients with nonsyndromic CLP taken between 2012 and 2019 at a single tertiary referral center. All assessments were performed independently by 4 observers (a head and neck radiologist and 3 orthodontists, including 2 fellowship-trained cleft-craniofacial orthodontists ). The images were divided into 9 anatomical areas and screened using serial axial slices and 3D reconstructions. The absolute number of IFs was reported for each area and statistical analysis was performed. RESULTS Incidental findings were found in 106 (95.5%) of the 111 patients. The most common sites were the maxilla (87.4%, principally dental anomalies), paranasal sinuses (46.8%, principally inflammatory opacification), and inner ear cavities (18.9%, principally inflammatory opacification). Eleven patients had skull malformations. Thirty-three patients had IFs in 1 anatomical area, 49 patients in 2 anatomical areas, 19 patients in 3 areas, and 5 patients presented with IFs in 4 of the 9 anatomical areas. DISCUSSION In patients with CLP, IFs on CBCT exam were present in the majority of cases. Most patients with IFs had them in multiple anatomical areas of the head and neck. The maxillary dental-alveolar complex was the most common area. Inflammatory changes in the inner ear cavities and paranasal sinuses were also common; however, cervical spine and skull abnormalities were also identified. Clinicians caring for patients with CLP should be aware of IFs, which may warrant further investigation and treatment.
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Affiliation(s)
| | - Ilana Ickow
- Department of Plastic and Reconstructive Surgery, The John Hopkins University School of Medicine, Baltimore, MD
| | - Joici Job
- Department of Radiology, Ohio State University, Columbus, OH, USA
| | - Jack E Brooker
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lucas A Dvoracek
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Rigby
- Law Office of Erick Rigby, Washington, PA, USA
| | - Nilesh Shah
- School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy Chen
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barton Branstetter
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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De Paepe J, Dochy F, Willems S, Van Hoecke H, De Leenheer E. Ear- and hearing-related impact on quality of life in children with cleft palate: Development and pretest of a health-related quality of life (HRQOL) instrument. Int J Pediatr Otorhinolaryngol 2019; 122:35-39. [PMID: 30933842 DOI: 10.1016/j.ijporl.2019.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/17/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To investigate to what extent middle ear problems and associated hearing loss affect quality of life (QoL) of children born with a cleft palate. METHODS Fifty-five children aged between 6 and 18 years, born with non-syndromic cleft palate ± cleft lip (CP/L) were included. A new health-related quality of life (HRQOL) questionnaire was generated with consideration of the following domains of QoL: communication, hearing loss, physical symptoms, limitation of activities and socio-emotional impact. RESULTS Major psychosocial problems were not reported in the majority of children as a result of their ear and hearing problems. However, according to their parents, 2 out of 3 children, had difficulty speaking clearly and understandably. These communication problems led to behavioural problems and social isolation in 1 out of 5 children. Scholastic achievement was negatively influenced by two factors: hearing loss and sleep disturbance due to ear problems. CONCLUSIONS To our knowledge this is the first study to quantitatively measure the ear- and hearing-related impact on QoL in children born with CP/L. Large-scale, multicentre studies are needed to further research and expand on the findings of this pilot study.
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Affiliation(s)
- Justine De Paepe
- Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Frederick Dochy
- Department of Head and Skin, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Head and Skin, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Els De Leenheer
- Department of Head and Skin, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
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Rieu-Chevreau C, Lavagen N, Gbaguidi C, Dakpé S, Klopp-Dutote N, Page C. Risk of occurrence and recurrence of otitis media with effusion in children suffering from cleft palate. Int J Pediatr Otorhinolaryngol 2019; 120:1-5. [PMID: 30735917 DOI: 10.1016/j.ijporl.2019.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/29/2019] [Accepted: 01/29/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Caroline Rieu-Chevreau
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Medical Center, Amiens, France
| | - Nolwenn Lavagen
- Department of Maxillofacial Surgery, Amiens University Medical Center, Amiens, France
| | - Cica Gbaguidi
- Department of Maxillofacial Surgery, Amiens University Medical Center, Amiens, France
| | - Stéphanie Dakpé
- Department of Maxillofacial Surgery, Amiens University Medical Center, Amiens, France
| | - Nathalie Klopp-Dutote
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Medical Center, Amiens, France
| | - Cyril Page
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Medical Center, Amiens, France.
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Ozawa S, Mans C, Miller JL, Snyder C, Fazio C. Cleft Palate in a Chinchilla (Chinchilla lanigera). J Exot Pet Med 2019. [DOI: 10.1053/j.jepm.2017.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Jin L, Li K, Li X. Clinical outcomes of otitis media with effusion following palatoplasty in patients with incomplete cleft palate. Acta Otolaryngol 2019; 139:1-5. [PMID: 30712437 DOI: 10.1080/00016489.2018.1522449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Diagnosis and treatment strategies for CP with OME and the timing of ear tube insertion remain controversial. OBJECTIVES To analyze the clinical outcomes of otitis media with effusion in children with incomplete cleft palate after palatoplasty prospectively. METHODS A total of 30 children (10 months-2 years old) with incomplete CP were enrolled in this study and received at least 6 months of follow-up evaluations after palatoplasty. RESULTS The overall improvement rate of OME was as high as 26% in this group. Average air conduction hearing threshold was significantly better than that before surgery in the 8 patients with improved OME (p < .05). Among the 8 children with improved OME, 7 (87.5%) were found to have middle ear effusion that improved within 6 months after CP repair. There was no significant difference in the improvement rate between the severe degree II group and the mild group. CONCLUSION A 6-month follow-up period is recommended. The severity of incomplete CP is not fully related to the function of the eustachian tube. SIGNIFICANCE The overall improvement rate was as high as 26%, and effusion in the tympanic cavity subsided in 7 out of 8 cases within 6 months after the CP repair.
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Affiliation(s)
- Lei Jin
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Department of Otolaryngology, Head and Neck Surgery, Shanghai, China
| | - Keyong Li
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Department of Otolaryngology, Head and Neck Surgery, Shanghai, China
| | - Xiaoyan Li
- Shanghai Children's Hospital, Shanghai Jiao Tong University, Department of Otolaryngology, Head and Neck Surgery, Shanghai, China
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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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18
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Werker CL, van den Aardweg MTA, Coenraad S, Mink van der Molen AB, Breugem CC. Internationally adopted children with cleft lip and/or cleft palate: Middle ear findings and hearing during childhood. Int J Pediatr Otorhinolaryngol 2018; 111:47-53. [PMID: 29958613 DOI: 10.1016/j.ijporl.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adopted children with cleft lip and/or cleft palate form a diverse group of patients. Due to increased age at palatal repair, adopted children have a higher risk of velopharyngeal insuffiency and poor speech outcome. Delayed palate repair may also lead to longer lasting Eustachian tube dysfunction. Decreased function of the Eustachian tube causes otitis media with effusion and recurrent acute otitis media, which can lead to other middle ear problems and hearing loss. METHODS One-hundred-and-thirty-two adopted children treated by the Cleft palate team in Wilhelmina Children's Hospital during January 1994 and December 2014 were included. Retrospectively, middle ear findings, the need for ventilation tube insertion and hearing during childhood were assessed. Findings were compared with 132 locally born children with cleft lip and/or cleft palate. RESULTS Adopted children had a mean age of 26.5 months old when they arrived in our country. After the age of two the total number of otitis media with effusion episodes and the need for ventilation tube placement did not significantly differ among adopted and non-adopted children. Adopted children had significantly more tympanic membrane perforations. Hearing threshold levels normalized with increasing age. Although within normal range, adopted children showed significantly higher pure tone averages than locally born children when they were eight to ten years old. CONCLUSION In general, adopted patients with cleft lip and/or cleft palate did not have more middle ear problems or ventilation tubes during childhood. However, theyhave more tympanic membrane perforations.
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Affiliation(s)
- C L Werker
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - M T A van den Aardweg
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - S Coenraad
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - C C Breugem
- Department of Plastic Surgery and Department of Otolaryngology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
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Whittemore KR, Dargie JM, Dornan BK, Boudreau B. Otolaryngology Service Usage in Children With Cleft Palate. Cleft Palate Craniofac J 2018; 55:743-746. [DOI: 10.1177/1055665617752210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Design: Retrospective case series. Setting: Specialty clinic at a pediatric tertiary care hospital. Patients: Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Main Outcome Measures: Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). Results: In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Conclusions: Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.
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Affiliation(s)
- Kenneth R. Whittemore
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Jenna M. Dargie
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
| | - Briana K. Dornan
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
| | - Brian Boudreau
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA, USA
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20
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Markey J, Maine R, Daniels K, Yu EY, Gregory G, Hoffman W, Palacios J. Otologic Disease Following Palatoplasty In International Cleft Palate Cohort. Cleft Palate Craniofac J 2018; 55:162-167. [PMID: 29351047 DOI: 10.1177/1055665617726998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Study the prevalence of otologic disease in a pediatric post-palatoplasty population with no prior ear tube placement in resource-deprived countries and assess patient characteristics associated with these abnormal results. DESIGN Retrospective data review. PARTICIPANTS Ecuadorian and Chinese children identified during humanitarian cleft lip and palate repair trips with cleft palates undergoing palatoplasty from 2007 to 2010. INTERVENTIONS Tympanometry and otoacoustic emission (OAE) testing performed following palatoplasty. Patients' parents administered surveys regarding perceived hearing deficits. MAIN OUTCOME MEASURES Age, gender, Veau classification, follow-up time, laterality, and country of origin were evaluated for possible association with type B tympanogram, "Refer" Otoacoustic results, and presence of hearing difficulty as identified by a parent. Significant predictors were further evaluated with multivariate analysis. RESULTS The cohorts included 237 patients (129 Ecuadorian, 108 Chinese); mean age: 3.9 years; mean follow-up: 4.2 years. Thirty-nine percent scored type B, 38% failed OAE testing, and 8% of parents noted hearing deficits. The country of origin and a younger age were identified as predictive variables regarding type B tympanogram. Follow-up time, country of origin, and bilateral OAE "Refer" results all significantly predicted parental questionnaire results. Subsequent multivariable analysis further demonstrated effect modification between the 2 variables of age at palatoplasty and country of origin when predicting type B vs type A tympanometry. CONCLUSION Without otologic intervention, cleft palate children in resource-deprived settings suffer type B tympanometry and failed OAE results with similar to increased incidences to other studied cleft palate populations with otologic interventions available.
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Affiliation(s)
- Jeff Markey
- 1 Department of O-HNS, Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA
| | - Rebecca Maine
- 2 UCSF Department of Surgery, University of California, San Francisco, CA, USA
| | - Kimberly Daniels
- 3 Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Emily Yang Yu
- 2 UCSF Department of Surgery, University of California, San Francisco, CA, USA
| | | | - William Hoffman
- 5 Division of Plastic and Reconstructive Surgery, University of California, San Francisco, CA, USA
| | - Jorge Palacios
- 6 Division of Plastic and Reconstructive Surgery, University of Guayaquil, Guayaquil, Ecuador
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21
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Padia R, Hall D, Sjogren P, Narayanan P, Meier JD. Sequelae of Tympanostomy Tubes in a Multihospital Health System. Otolaryngol Head Neck Surg 2018; 158:930-933. [DOI: 10.1177/0194599817752633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Reema Padia
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel Hall
- Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA
| | - Phayvanh Sjogren
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Prem Narayanan
- Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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22
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Crerand CE, Kapa HM, Litteral J, Pearson GD, Eastman K, Kirschner RE. Identifying Psychosocial Risk Factors Among Families of Children With Craniofacial Conditions: Validation of the Psychosocial Assessment Tool-Craniofacial Version. Cleft Palate Craniofac J 2018; 55:536-545. [PMID: 29315004 DOI: 10.1177/1055665617748010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of the Psychosocial Assessment Tool-Craniofacial Version (PAT-CV), a screening instrument for psychosocial risk in families of children with craniofacial conditions, and to examine risk classification of patients in a craniofacial population. DESIGN Prospective, cross-sectional, single-center study. SETTING Interdisciplinary cleft lip and palate/craniofacial center at a US children's hospital. PARTICIPANTS Parents/caregivers (n = 242) of 217 children ages 1 month to 17 years being treated for a congenital syndromic or nonsyndromic craniofacial condition completed the PAT-CV and validating measures from July 2015 to July 2016. The PAT-CV was completed by 121 caregivers a second time to assess test-retest reliability. MAIN OUTCOME MEASURES PAT-CV, Child Behavior Checklist, Adult Self-Report, Pediatric Quality of Life Inventory, Craniofacial Experiences Questionnaire, and Family Environment Scale. RESULTS Construct validity of the PAT-CV was supported by significant correlations ( P < .001) between PAT-CV total and subscale scores and the validated measures. PAT-CV total scores categorized 59.9% of families within the universal risk group, 32.3% within the targeted risk group, and 7.8% within the clinical range. Good criterion validity was indicated by significantly higher scores ( P < .0001) obtained on the validated measures for those in the targeted and clinical risk groups. Internal consistency (Cronbach's α = 0.86) and test-retest reliability for the PAT-CV total score ( r = 0.77, P < .0001) were acceptable. CONCLUSIONS The PAT-CV appears to be a reliable and valid screening instrument for psychosocial risk. Accurate identification of risk and implementation of appropriate interventions may contribute to improvements in medical and psychosocial outcomes.
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Affiliation(s)
- Canice E Crerand
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- 2 Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hillary M Kapa
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory D Pearson
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Katherine Eastman
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard E Kirschner
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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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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Padia R, Alt JA, Curtin K, Muntz HR, Orlandi RR, Berger J, Meier JD. Environmental contributions to otitis media requiring tympanostomy tubes. Int J Pediatr Otorhinolaryngol 2017; 101:97-101. [PMID: 28964318 DOI: 10.1016/j.ijporl.2017.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Otitis media requiring tympanostomy tubes (OMwTT) is a prevalent disease process that has been previously shown to have a strong familial link. The impact from the environmental versus genetic contributions to this link is unknown. The objective was to determine the environmental involvement in the development of OMwTT. METHODS Using an extensive genealogical database linked to medical records, we evaluated the risk of OMwTT in children of probands as compared to children of controls, individually matched 5:1 on sex and birth year, from a conditional logistic regression model. The model included adjustments for geographic and socioeconomic environmental risk factors mapped to residence location of study subjects within 63 small health statistical areas of ∼33,500 persons each. RESULTS 37,814 case probands diagnosed with OMwTT and 181,339 controls were included in our analysis. Children of probands with OMwTT had an overall 2.5× higher risk of also having OMwTT as compared to the children of controls (p < 10-9), independent of environmental factors (PM2.5 [particulate matter] air pollution, education level of parents, and density of primary care providers). CONCLUSION After accounting for geographic and socioeconomic differences that may influence risk between cases and controls, our findings suggest evidence of a genetic predisposition in families of OMwTT patients. Further characterization of high-risk pedigrees is needed for future genomic studies.
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Affiliation(s)
- Reema Padia
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, United States
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, United States
| | - Karen Curtin
- Division of Genetic Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, United States; Pedigree & Population Resource, Huntsman Cancer Institute, University of Utah, United States
| | - Harlan R Muntz
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, United States
| | - Richard R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, United States
| | - Justin Berger
- Pedigree & Population Resource, Huntsman Cancer Institute, University of Utah, United States
| | - Jeremy D Meier
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, United States.
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Imbery TE, Sobin LB, Commesso E, Koester L, Tatum SA, Huang D, Wang D, Nicholas BD. Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate. Otolaryngol Head Neck Surg 2017; 157:676-682. [DOI: 10.1177/0194599817707514] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center. Methods Charts of 564 patients with a diagnosis of cleft palate (59% syndromic etiology, 41% nonsyndromic) from 1998 to 2014 were reviewed. Patients without at least 1 audiometric follow-up were excluded from analysis. Patient demographics, surgeries, audiometric tests, and otologic data were recorded for 352 patients. Results Forty-five percent had isolated cleft palates, 34% had unilateral cleft lip and palate, and 21% had bilateral cleft lip and palate. Patients were followed for a mean of 50.3 months with a mean of 3.2 separate audiograms performed. Patients received a mean of 2.93 pressure equalization tubes. Increased number of pressure equalization tubes was not associated with incidence of cholesteatoma, which was identified in only 4 patients. Nine patients underwent eventual tympanoplasty with an 89% closure rate. Analysis of mean air-bone gap by cleft type did not reveal significant differences ( P = .08), but conductive losses and abnormal tympanometry persisted into teenage years. Conclusions Patients with cleft palates have eustachian tube dysfunction, which, in our cohort, resulted in persistent conductive hearing loss, highlighting the importance of long-term follow-up. Cholesteatoma incidence was low and not associated with number of tubes, which at our institution were placed prophylactically. Tympanoplasty was successful in those with persistent perforations.
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Affiliation(s)
- Terence E. Imbery
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Lindsay B. Sobin
- Department of Otolaryngology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Emily Commesso
- School of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Lindsey Koester
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sherard A. Tatum
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, New York, USA
- Cleft and Craniofacial Center, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Danning Huang
- Center for Research and Evaluation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Dongliang Wang
- Center for Research and Evaluation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Brian D. Nicholas
- Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, New York, USA
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Shaffer AD, Ford MD, Choi SS, Jabbour N. The Impact of Tympanostomy Tubes on Speech and Language Development in Children with Cleft Palate. Otolaryngol Head Neck Surg 2017; 157:504-514. [PMID: 28462671 DOI: 10.1177/0194599817703926] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Describe the impact of hearing loss, tympanostomy tube placement before palatoplasty, and number of tubes received on speech outcomes in children with cleft palate. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods Records from 737 children born between April 2005 and April 2015 who underwent palatoplasty at a tertiary children's hospital were reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, sensorineural or mixed hearing loss, no tubes, first tubes after palatoplasty, or first clinic after 12 months of age. Data from 152 patients with isolated cleft palate and 166 patients with cleft lip and palate were analyzed using Wilcoxon rank-sum, χ2, and Fisher exact test and logistic regression. Results Most patients (242, 76.1%) received tubes before palatoplasty. Hearing loss after tubes, but not before, was associated with speech/language delays at 24 months ( P = .005) and language delays ( P = .048) and speech sound production disorders (SSPDs, P = .040) at 5 years. Receiving tubes before palatoplasty was associated with failed newborn hearing screen ( P = .001) and younger age at first posttubes type B tympanogram with normal canal volume ( P = .015). Hearing loss after tubes ( P = .021), language delays ( P = .025), SSPDs ( P = .003), and velopharyngeal insufficiency ( P = .032) at 5 years and speech surgery ( P = .022) were associated with more tubes. Conclusion Continued middle ear disease, reflected by hearing loss and multiple tubes, may impair speech and language development. Inserting tubes before palatoplasty did not mitigate these impairments better than later tube placement.
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Affiliation(s)
- Amber D Shaffer
- 1 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Matthew D Ford
- 2 Division of Cleft Craniofacial Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Sukgi S Choi
- 1 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Noel Jabbour
- 1 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Impact of pharyngofixation in cleft palate repair surgery on the development of chronic adhesive otitis media. The Journal of Laryngology & Otology 2017; 131:645-649. [PMID: 28325168 DOI: 10.1017/s0022215117000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A significant percentage of children with cleft palate suffer from otitis media with effusion and its consequences, such as deafness, chronic adhesive otitis and cholesteatoma. This study aimed to determine whether these effects can be minimised by selecting pharyngofixation as the surgical technique for cleft palate correction. METHODS A retrospective study was performed of 155 patients (308 ears) who underwent surgery from age 5 months to 8 years and were followed up for 36-84 months. RESULTS In all, 125 ears (41 per cent) had epitympanic retraction, 45 ears (14 per cent) had sinus tympani retraction and 5 patients (3 per cent) had cholesteatoma. Use of the pharyngofixation technique did not significantly correlate with (1) the severity of otological findings or (2) the incidence of retraction pockets in the epitympanum and sinus tympani (p = 0.53). CONCLUSION Pharyngofixation did not significantly alter the severity of long-term otological findings.
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Fitzsimons KJ, Copley LP, Van Der Meulen JH, Panagamuwa C, Deacon SA. Grommet Surgery in Children with Orofacial Clefts in England. Cleft Palate Craniofac J 2017; 54:80-89. [DOI: 10.1597/15-047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England. Design Analysis of national administrative data of hospital admissions. Setting National Health Service hospitals, England. Patients Patients born between 1997 and 2005 who underwent surgical cleft repair. Intervention Children receiving grommets before the age of 5 years. Outcome Measures The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. Results The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. Conclusion Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.
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Affiliation(s)
- Kate J. Fitzsimons
- CRANE Database, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Lynn P. Copley
- CRANE Database, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Jan H. Van Der Meulen
- CRANE Database, Clinical Effectiveness Unit, Royal College of Surgeons of England, and Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Channa Panagamuwa
- Consultant Paediatric Ear, Nose, and Throat Surgeon, Department of Ear, Nose and Throat, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Scott A. Deacon
- CRANE Database, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- South West Cleft Unit, Bristol Dental Hospital, Bristol, United Kingdom
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Padia R, Alt JA, Curtin K, Muntz HR, Orlandi RR, Berger J, Meier JD. Familial link of otitis media requiring tympanostomy tubes. Laryngoscope 2016; 127:962-966. [PMID: 27861935 DOI: 10.1002/lary.26360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/08/2016] [Accepted: 09/09/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Placement of tympanostomy tubes for recurrent or chronic otitis media is the most commonly performed ambulatory procedure in the United States. Etiologies have been speculated to be environmentally based, and studies have suggested a genetic component to the disease. However, no large-scale studies have attempted to define a familial component. The objective of this study was to determine the familial risk of otitis media requiring tympanostomy tubes (OMwTT) in a statewide population. STUDY DESIGN Retrospective observational cohort study with population-based matched controls. METHODS Using an extensive genealogical database linked to medical records, the familial risk of OMwTT was calculated for relatives of probands (46,249 patients diagnosed with OMwTT from 1996-2013) compared to random population controls matched 5:1 on sex and birth year from logistic regression models. RESULTS The median age at time of tympanostomy tube placement was 1 year (interquartile range, 0-2 years). First-degree relatives of patients with OMwTT, primarily siblings, had a 5-fold increased risk of OMwTT (P < 10-16 ). Second-degree relatives were at a 1.5-fold increased risk (P < 10-15 ). More extended relatives (third, fourth and fifth degree) showed a 1.4-fold increased risk (P < 10-15 ). CONCLUSIONS In the largest population-based study to date, a significant familial risk is confirmed in OMwTT, suggesting otitis media may have a significant genetic component given the increased risk found in close as well as distant relatives. This could be influenced by shared environments given a five-times risk observed in siblings. Further understanding the genetic basis of OMwTT and its interplay with environmental factors may clarify the etiology and lead to better detection of disease and treatments. LEVEL OF EVIDENCE 3b. Laryngoscope, 127:962-966, 2017.
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Affiliation(s)
- Reema Padia
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Karen Curtin
- Pedigree and Population Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, U.S.A
| | - Harlan R Muntz
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Richard R Orlandi
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Justin Berger
- Pedigree and Population Resource, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jeremy D Meier
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
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Alper CM, Losee JE, Seroky JT, Mandel EM, Richert BC, Doyle WJ. Resolution of Otitis Media With Effusion in Children With Cleft Palate Followed Through Five Years of Age. Cleft Palate Craniofac J 2016; 53:607-13. [PMID: 27533493 PMCID: PMC5074527 DOI: 10.1597/15-130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the temporal pattern of otitis media with effusion (OME) resolution for a cohort of nonsyndromic cleft palate children enrolled before palatoplasty and followed through 5 years of age. DESIGN This is a prospective, longitudinal study of the time course for OME resolution in infants and children with palatal clefts. SETTING Cleft Palate Craniofacial Center of a tertiary care pediatric hospital. PARTICIPANTS This study included 52 children with cleft palate (29 boys, 45 white, Veau 1 through 4) who had a Furlow-type palatoplasty between 10 and 24 months of age performed by one of six surgeons. INTERVENTIONS Standard cleft palate management was supplemented with study visits to the research clinic pre- and postpalatoplasty and then yearly to 6 years of age for assessments of middle ear status by interval history, otoscopy, and tympanometry. MAIN OUTCOME MEASURE The main outcome measure was age at otitis media resolution defined as the age in years at the first in a sequence of "disease-free" diagnoses not interrupted or followed by any other diagnosis. RESULTS The cumulative percent OME resolution for ears/children at ages <1, 1, 2, 3, 4, 5 years was 4.1/4.4, 14.3/10.9, 31.6/21.7, 45.9/37.0, 56.1/50.0, and 70.4/60.9%. OME resolution followed a simple linear time curve with slopes of 13.5% (confidence interval [CI] = 12.2% to 14.8%, r(2) = .99) and 11.9% (CI = 10.1% to 13.6%, r(2) = .99) resolutions per year for ears and children, respectively. CONCLUSIONS There is a natural, age-related pattern of resolution for persistent OME that affects most infants and young children with cleft palate that is not affected by palatoplasty.
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Affiliation(s)
- Cuneyt M. Alper
- Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - Joseph E. Losee
- Department of Plastic Surgery, Children’s Hospital of Pittsburgh of the UPMC and the University of Pittsburgh School of Medicine
| | - James T. Seroky
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - Ellen M. Mandel
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - Beverly C. Richert
- Division of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - William J. Doyle
- Department of Otolaryngology, University of Pittsburgh School of Medicine
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Huang CY, Wu CS, Tang CH, Wang MC, Kuo TY, Tu TY. Palatoplasty decreases the re-insertion rate of middle ear ventilation tube in cleft palate children - A population-based birth cohort study. Acta Otolaryngol 2016; 136:768-74. [PMID: 27067029 DOI: 10.3109/00016489.2016.1165352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONCLUSION Palatoplasty can significantly decrease their middle ear re-intubation rate with a relatively lower hazard ratio compared to children who underwent VTI only. OBJECTIVES In children with cleft palate, questions remain about the overall effect of ventilation tube insertion (VTI) and palatoplasty for their OME. A large-scale study might offer more evidence for the roles of palatal surgery. SUBJECTS AND METHODS This was a retrospective birth cohort study based upon a national database. We analyzed children born between 1999-2004 and diagnosed as cleft palate and/or lips. These children, according to their surgeries, were separated into two groups: (1) VTI only, and (2) VTI and palatoplasty. Kaplan-Meier analysis and log-rank test were used to calculate their cumulative tube re-insertion rates. Their hazard ratios of tube re-insertion were also analyzed. RESULTS In total, 1205 cleft children were collected, with 151 in the VTI only group and 1054 in the VTI + palatoplasty group. Ventilation tube re-insertion rates were significantly lower in the VTI + palatoplasty group (p = 0.002). The cumulative re-insertion rates also showed a significant difference (p = 0.001). When compared to the VTI only group, the adjusted hazard ratio was 0.528 in the VTI + palatoplasty group (p = 0.001).
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Affiliation(s)
- Chii-Yuan Huang
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Otolaryngology, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Chuan-Song Wu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
- College of Science and Engineering, and Graduate School of Business Administration, Fu-Jen Catholic University, Taipei, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Mao-Che Wang
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yu Kuo
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzong-Yang Tu
- Department of Otolaryngology Head Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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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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Sundman H, Flynn T, Tengroth B, Lohmander A. ABR thresholds in infants born with CLP and OME and infants with OME. Int J Pediatr Otorhinolaryngol 2016; 81:21-5. [PMID: 26810283 DOI: 10.1016/j.ijporl.2015.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 11/02/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate and compare auditory brainstem response (ABR) thresholds related to otitis media with effusion (OME) in infants with and without cleft palate and/or lip (CP±L). METHODS Forty-seven infants with CP±L and 67 infants with OME participated in the study. Hearing thresholds of ears of infants with OME were compared between groups and within the group with CP±L. RESULTS Infants with CP±L and OME presented with similar hearing thresholds as infants with OME and not CP±L. Within the cleft group, infants with isolated cleft palate and OME demonstrated significantly higher hearing thresholds than infants with unilateral cleft lip and palate and OME. CONCLUSION A high prevalence of infants with CP±L present with OME early in life. Hearing thresholds of these infants are similar to infants without CP±L, but with OME. The ear status and hearing thresholds of infants with CP±L needs to be monitored to be able to provide the best access to hearing in order to fully allow speech and language development.
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Affiliation(s)
- H Sundman
- Hearing and Balance Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - T Flynn
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - B Tengroth
- Hearing and Balance Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - A Lohmander
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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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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Eastwood MP, Hoo KH, Adams D, Hill C. The Role of Screening Audiometry in the Management of Otitis Media with Effusion in Children with Cleft Palate in Northern Ireland. Cleft Palate Craniofac J 2014; 51:400-5. [DOI: 10.1597/12-276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To determine uptake and outcome of hearing screening in the cleft palate population in Northern Ireland (NI) and the rate of ventilation tube (VT) insertion over a 3-year period. Design In NI, hearing screening is offered in the neonatal period, at 9 months in the community, and at 2.5 years in the joint cleft clinic. Patients Eighty-five children with cleft palate born between 2006 and 2008 in NI were eligible for all three screenings. Methods A retrospective case note review was performed of tympanograms, audiometry, and VT insertion rates at each of the three time points. Results In the neonatal period, all patients eligible were screened; 66 (77.6%) patients passed the screening, with 19 patients (22.4%) failing, resulting in direct referral to ENT for consideration of VT. Results of the 9-month community screening were not made routinely available to the regional cleft service. At the 2.5-year clinic screening, all attending patients (n = 80) had documented screening. Fifty-two (65%) patients passed screening, with 28 patients (35%) failing screening. Forty-six patients (57.5%) had documented VT, and 9 (11.25%) were awaiting ENT review for consideration of VT. Conclusion Ventilation tubes are not routinely inserted at the time of cleft repair in the NI population, and 57.5% of our cleft population has ventilation tubes inserted by 2.5 years. Cleft patients in NI have regular routine hearing assessments, and our current practice avoids universal ventilation tube insertion while identifying those who need further hearing management. Further research is needed to reach an international consensus on the insertion of VT in cleft patients.
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Affiliation(s)
- Mary P. Eastwood
- Plastic Surgery, Ulster Hospital Dundonald, Belfast, Northern Ireland
| | - Koh H. Hoo
- Plastic Surgery, Ulster Hospital Dundonald, Belfast, Northern Ireland
| | - David Adams
- ENT, Royal Victoria Hospital, Belfast, Northern Ireland
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Abstract
OBJECTIVE To determine outcomes of type 1 cartilage tympanoplasty in a cohort of pediatric patients with a history of cleft palate repair. PATIENTS AND OUTCOME MEASURES Retrospective chart review and comparison with a historical control group of patients with no cleft palate anomaly undergoing the same procedure by the same surgeon at a tertiary care pediatric hospital. A total of 37 patients between ages 4 and 19 years inclusive (45 ears), with a history of repaired cleft palate, underwent type 1 cartilage tympanoplasty with or without primary tube insertion from September 2004 to October 2012. Demographics, type of cleft palate, surgical indication, middle ear status, complications, history of myringotomy tube insertion, and auditory outcomes were collected. Results were compared with those for a non-cleft palate cohort that had undergone the same procedure, which had been previously published. RESULTS The unadjusted average preoperative and postoperative pure-tone averages for patients with a history of cleft palate were 22.06 and 7.29, respectively, compared with 18.34 and 8.32, respectively, for non-cleft patients. Despite significantly worse preoperative hearing levels among the cleft palate group, there was no statistically significant difference in outcomes with regard to hearing results between the two groups. One patient in the cleft palate group required revision type 1 cartilage tympanoplasty for graft failure, which is comparable to that reported for non-cleft palate patients. Post-tympanoplasty secondary tympanostomy intubation was slightly higher for the cleft palate population. CONCLUSION Type 1 cartilage tympanoplasty, when performed in a pediatric population with a history of cleft palate, can achieve closure and hearing results that are comparable of those in patients with no such anomaly.
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Jordan VA, Sidman JD. Hearing outcomes in children with cleft palate and referred newborn hearing screen. Laryngoscope 2014; 124:E384-8. [DOI: 10.1002/lary.24727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/05/2014] [Accepted: 04/16/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Victoria A. Jordan
- University of Minnesota Medical School, Children's Hospitals and Clinics of Minnesota; Minneapolis Minnesota U.S.A
| | - James D. Sidman
- Department of Otolaryngology-Head and Neck Surgery; Children's Hospitals and Clinics of Minnesota; Minneapolis Minnesota U.S.A
- Children's ENT and Facial Plastic Surgery, Children's Hospitals and Clinics of Minnesota; Minneapolis Minnesota U.S.A
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Abstract
BACKGROUND Otitis media with effusion (OME) as the most common cause of hearing loss in childhood plays an important role in the follow-up after failed newborn hearing screening (NHS). The introduction of the NHS allows OME to be diagnosed and treated in the first months of life. MATERIAL AND METHODS In 715 children referred to the Department of Phoniatrics and Pedaudiology of the Ear, Nose, Throat University Hospital of Magdeburg during the period 2006-2010, the prevalence and therapy process of OME during follow-up could be determined. RESULTS OME was diagnosed in 16 % of the patients. Spontaneous resolution was observed in 37 % of the cases, while 46 % of the children were treated surgically. A substantially increased risk for persistent OME was observed in children with craniofacial dysmorphia or cleft palate. CONCLUSION Using NHS, OME can be diagnosed and treated early, thus, preventing potential problems in the linguistic, social and intellectual development of children.
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Skuladottir H, Sivertsen A, Assmus J, Remme AR, Dahlen M, Vindenes H. Hearing outcomes in patients with cleft lip/palate. Cleft Palate Craniofac J 2014; 52:e23-31. [PMID: 24805872 DOI: 10.1597/13-009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Children with cleft lip and palate or cleft palate only have a high incidence of conductive hearing loss from otitis media with effusion. Studies demonstrating longitudinal results are lacking. This study was undertaken to investigate long-term longitudinal hearing outcomes of children with cleft lip and/or cleft palate and cleft palate only. Design : Retrospective chart review. Setting : Clinical charts of patients born with cleft lip and palate or cleft palate only in 1985 to 1994 who were referred to the cleft team in Bergen, Norway. Study findings include 15 years of follow-up. Participants : The study population consisted of 317 children of whom 159 had nonsyndromic cleft lip and palate and 158 had nonsyndromic cleft palate. Main Outcome Measures : Pure tone average calculated from pure tone audiometry at ages 4, 6, and 15 years. Results : The median pure tone average significantly improved with increasing age. For the cleft lip and palate group, the median pure tone average at ages 4, 6, and 15 years was 16 dB hearing level (HL), 13 dB HL, and 9 dB HL, respectively (P ≤ .001). In the cleft palate group the median pure tone average at ages 4, 6, and 15 years was 15 dB HL, 12 dB HL, and 9 dB HL, respectively (P ≤ .001). There was no significant difference in the hearing levels between the two groups. Patients who had surgical closure of the palate at age 18 months had a significantly better pure tone average outcome at age 15 compared with patients who had surgery at 12 months. Conclusions : Hearing improves significantly from childhood to adolescence in patients with cleft lip and palate and cleft palate only.
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Kuo CL, Lien CF, Chu CH, Shiao AS. Otitis media with effusion in children with cleft lip and palate: a narrative review. Int J Pediatr Otorhinolaryngol 2013; 77:1403-9. [PMID: 23931986 DOI: 10.1016/j.ijporl.2013.07.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Repair surgery of cleft lip and palate (CLP) can produce satisfactory cosmetic results but the problem of recurrent otitis media with effusion (OME) secondary to CLP may persist. This can cause long-term hearing loss and affect linguistic, academic, and personal development. The aim of this review is to provide the most recent information regarding OME in children with CLP. METHODS All papers referring to children with CLP and OME were identified from searches in Medline, PubMed, Cochrane Library, and Web of Science. Abstracts were read and relevant papers were obtained. Additional studies were obtained from the references of the selected articles. RESULTS Both current and previous research on OME in children with CLP focused on the controversy over treatment strategies. Evidence on the optimal treatment for OME in CLP children was lacking. Ventilation tube surgery using the same anesthetic as lip or palate procedures was not well-supported. After summarizing the literature review, a flowchart of management guidance for such patients is also recommended. Updated reviews such as this will provide clinicians and patients/parents with a valuable reference. CONCLUSIONS The lack of evidence on the optimal treatment for OME in children with CLP should prompt a relatively conservative approach. However, only a consensus between patients/parents and surgeons regarding the most suitable treatment strategy for OME can ensure the greatest benefit to individual patients.
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Affiliation(s)
- Chin-Lung Kuo
- Department of Otorhinolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC
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Kobayashi H, Sakuma T, Yamada N, Suzaki H. Clinical outcomes of ventilation tube placement in children with cleft palate. Int J Pediatr Otorhinolaryngol 2012; 76:718-21. [PMID: 22386274 DOI: 10.1016/j.ijporl.2012.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 02/01/2012] [Accepted: 02/03/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the long-term clinical outcomes in children with cleft palate. METHODS One hundred eight patients with cleft palate (CP) were investigated. Microscopic observation of the middle ears was performed periodically. If chronic otitis media with effusion (OME) was diagnosed at 1 year of age or later, ventilation tube (VT) placement was performed. The air-filled area of the mastoid air cells was checked on X-rays obtained at 1 and 5 years. The data from each measurement were tested statistically by the bootstrap method and Wilcoxon's rank-sum test. The clinical course from age 6 to the final examination (average 9.42 years) and the language development at 5 years were analyzed using data from the medical records of individual patients. RESULTS VT placements were performed at 5 years of age or younger in 41 CP patients (82 ears, 38%). About 30% of patients treated by VT placement at 5 years of age or younger required myringotomy and/or VT re-placement at 6 years of age or over. Ninety-five percent of patients who had not been treated by VT insertion at 5 years of age or younger showed a favorable subsequent clinical course. Patients treated by VT insertion at 5 years of age or younger had significantly smaller mastoid air cell areas as measured at 5 years of age and also at 1 year of age. No significant difference in language development was observed between the CP patients that underwent /did not undergo VT placement. CONCLUSIONS VT placement should be positively undertaken in CP children who have small mastoid air cell areas as measured at 1 year of age, because an unfavorable prognosis of OME is expected in such patients. It is considered that patients treated by VT placement at 5 years of age or younger should be carefully followed up for the development of OME even after 6 years of age. Thus, measurement of the mastoid air cell area at the age of 1 year is useful for determining the therapeutic program.
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Affiliation(s)
- Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
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Knapik M, Saliba I. Myringoplasty in children with cleft palate and craniofacial anomaly. Int J Pediatr Otorhinolaryngol 2012; 76:278-83. [PMID: 22172220 DOI: 10.1016/j.ijporl.2011.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 11/20/2011] [Accepted: 11/21/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Analyze the anatomical and audiological success rates of myringoplasty in children with craniofacial anomaly, cleft palate and compare them to a control group. METHODS Retrospective review of medical records for all children who underwent myringoplasty between 1997 and 2007. The following data was recorded: sex, age, perforation side, size, location and etiology, surgical approach, type of myringoplasty, graft material, season of surgery, preoperative status of the operated and contralateral ear, history of previous otologic surgery, and adenoidectomy or tonsillectomy. RESULTS Myringoplasty outcomes of 22 craniofacial anomaly patients (15/22 were cleft palate patients) were compared to 144 controls. Children in the craniofacial anomaly group demonstrated a tendency towards surgery at an older age. Children in the craniofacial anomaly and cleft palate groups had a significant positive history of previous otologic procedures to both operated and contralateral ears. Peroperative subannular ventilation T-tubes were more frequently recorded in patients with craniofacial anomaly than patients in the control group. The craniofacial anomaly, cleft palate and control group had comparable mean preoperative and postoperative ABG and their ABG improvement was statistically significant. Children with craniofacial anomaly, cleft palate and control group shared similar anatomical and audiological success rates (ABG<20 dB) at 6, 12 and 24 months. CONCLUSIONS Although children in the craniofacial anomaly and cleft palate groups are predisposed to middle ear disease, their disease responds well to surgical intervention. Their audiological and anatomical success rates were equivalent to the ones observed in the control group. In light of our results, we recommend that myringoplasty in children with craniofacial anomaly and cleft palate be performed after the age of 12.
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Affiliation(s)
- Monika Knapik
- CHU Sainte-Justine, 3175, Côte Sainte-Catherine, Service ORL, Montréal (Qc) H3T 1C5, Canada
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