Pre- and post-palatoplasty Eustachian tube function in infants with cleft palate

Wideband Tympanometry (WBT) Features in Children with Cleft Palate and Otitis Media with Effusion Before and After Cleft Palate Surgery

Aims

In some cases, children with cleft palate undergo unnecessary tympanostomy along with palatoplasty because of inaccurate evaluations in determining the level of otitis media with effusion (OME). Recent studies have shown that wideband tympanometry (WBT) significantly contributes to the accurate evaluation of the middle ear status in children with cleft palate. Therefore, this study aimed to investigate WBT and auditory brainstem response (ABR) indices before and after cleft palate repair surgery.

Materials and Methods

The study involved 88 children with cleft palate, and ABR and WBT energy absorbance indices were measured in two phases. The first phase was conducted three months and three days prior to cleft palate repair surgery, and the second phase was carried out one, three, and six months after surgery.

Results

In the first phase, the energy absorbance index of low frequencies was below the normal range in all children, within the normal range at high frequencies in 78 children, and below the normal range in only 10 children three months before cleft palate surgery. In the second phase, the energy absorbance index and hearing thresholds at low frequencies after surgery showed a significant difference compared with the preoperative index (p = 0.001).

Conclusion

Monitoring WBT indices and hearing thresholds in children with cleft palate is effective in determining the appropriate surgery for children with otitis media with effusion (OME). Furthermore, the WBT plays a crucial role in accurately assessing middle ear function after cleft palate surgery.

Three-Dimensional Assessment of Eustachian Tube in Patients With Cleft Palate Versus Controls: A CBCT Study

To compare the morphological characteristics of the Eustachian tube (ET) between patients with cleft palate and healthy controls with the use of cone-beam computed tomography (CBCT).

Retrospective assessment of treated nonsyndromic patients with cleft palate and a control group.

CBCT images of 51 patients with cleft palate who had previously undergone surgery to close the cleft palate and a control group of 51 patients were included in this study. Syndromic patients were excluded.

The cleft group were divided into 3 groups according to the palatoplasty technique, which was done in the infancy period to close the cleft palate (Nadjmi modification of Furlow, Sommerlad, and V-Y pushback). Finally, ET length (ETL), ET angle, and auditory tube angle (ATA) were measured in all patients.

The ETL, ETA, and ATA in the cleft and the normal control groups were 29.73 ± 3.14 and 32.18 ± 3.34 mm, 33.18 ± 2.57 and 35.40 ± 3.93, and 141.64 ± 4.13 and 138.87 ± 4.96, respectively. All 3 features were statistically significant among the groups (All Ps < .05). ETL and ETA were significantly higher in Nadjmi modification of Furlow and Sommerlad palatoplasty techniques compared to the V-Y pushback technique, while there was no significant difference in the ATA between the palatoplasty groups.

Cleft palate can significantly affect the morphological characteristics of the ET. Type of the infancy palatoplasty can influence some of its dimensions.

Outcomes of Tympanoplasty After Cleft Palate Repair: A Systematic Review and Meta-analysis

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.

Relationship between cleft palate width and otitis media

Objectives

To investigate the relationship between cleft width and otitis media (OM) and to determine whether a wide cleft palate (CP) is a risk factor of the incidence, type, amount of middle ear effusion, and prolonged morbidity in OM.

Study Design

Retrospective cohort study.

Methods

Children with CP who underwent palatoplasty between 2014 and 2018 were analyzed. Cleft width was measured at palatoplasty. The incidence of otitis media with effusion (OME) and acute otitis media (AOM), the type and amount of middle ear effusion, and OME duration and age at resolution were assessed in relation to cleft width.

Results

One hundred eighteen children were included. The CP types were Veau I in 16, II in 35, III in 48, and IV in 19 patients. The incidence of OME and AOM before palatoplasty was 83.1% and 49.2%, respectively. Cleft width did not differ significantly between patients with or without OME but was significantly greater in those with, than in those without, AOM (p < .001), in those with mucoid, than in those with serous, effusion (p = .012), and in those with complete, than in those with partial, effusion (p = .01). Regardless of cleft width or type, OME persisted for a median duration of 50 months.

Conclusions

Cleft width was significantly associated with the incidence of AOM and the type and amount of middle ear effusion before palatoplasty. However, it was not significantly related to the incidence, age at resolution, or duration of OME. Regardless of cleft width or type, OM in children with CP requires long-term follow-up. Level of Evidence: 2b.

[Eustachian tube dysfunction after cleft palate surgery : Use of the latest diagnostics]

OBJECTIVE

In patients with cleft palate, a high incidence of chronic obstructive Eustachian tube dysfunction (ETD) is assumed after surgery. Consequently, an increased rate of retracted eardrum or cholesteatoma is expected. Even though no common standard for investigating ETD is available, the development of objective tests has increased during the past 10 years. This study aimed to investigate the incidence of persisting chronic obstructive ETD in adult patients with cleft palate surgically treated in early childhood by using a combination of diagnostic tools.

METHODS

Adult participants with cleft palate repair in early childhood were invited for a follow-up examination and compared to a control group. Examination included tympanometry, tubomanometry, the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and the Eustachian Tube Score 7 (ETS-7).

RESULTS

A total of 16 adult patients were re-examined after cleft palate surgery and compared to a control group of 40 healthy individuals. Significant differences were found in the median ETS‑7 (p < 0.0001) score but not in the median ETDQ‑7 (p = 0.09) score. Only 2 of the 32 investigated ears (6%) had pathologic scores in ETS‑7 and ETDQ‑7 (p = 0.09), whereas 5 (31%) cleft palate patients showed symptoms of chronic obstructive ETD according to ETS‑7. No patient had examination findings indicating a requirement for further treatment.

CONCLUSION

By combining diagnostic tools for ETD, a lower rate of persisting obstructive ETD in adults after cleft palate surgery was found than previously reported. Successful surgical treatment of cleft palate seems to lead to physiological Eustachian tube function in long-term follow up.

Middle-ear effusion in children with cleft palate: congenital or acquired?

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.

Pre-operative and post-operative audiological assessment in cleft lip and palate patients-a prospective study

Purpose

To assess association of audiological defects in cleft lip and palate (CLP) following two stage cheiloplasty and palatoplasty using clinical evaluation and otoscopy and effect of the surgical repair at an interval of one year.

Materials and methods

A pilot research study was performed on sixty CLP patients of 1-6 years of age reporting at Craniofacial & Research Centre, Dharwad, India between October 2016 to October 2018.Subjects were assessed based on history, clinical examination and otoscopy for audiometric defects including Serous otitis media (SOM), retraction pockets, impacted wax pre-palatoplasty and findings were compared with control group. Study group were followed up postoperatively at 1, 3, 6 and 12 months and statistical analysis was carried.

Results

Higher incidence of conductive audiological defects were noted in study group (96.6%) to control group (8.33%). Of the sixty cleft patients subjected to screening otoscopy, 58 subjects had significant findings like serous otitis media(12.07%), retraction pockets(23.14%), impacted wax(62.04%), bulging of tympanic membrane(3.45%) which were clinically unnoticed. Post palatoplasty no changes were noted at 1 and 3 months, however at 6- and 12months significant improvement was noted (55.17%), with three subjects lost to follow up (6.90%) and none presenting with permanent deafness.results.

Conclusion

Cleft anomalies occur in different degrees of severity and configuration with greater incidence of conductive hearing defects of 97%. Positive correlation was noted in cleft palate cases with significant improvement after palatoplasty at an earlier age. However, future long term studies are warranted for long term assessment of Eustachian tube function.conclusion.

Cone-Beam Computed Tomography Evaluation of the Eustachian Tube in Patients With Cleft Lip and Palate Compared With Normal Controls

The authors compared the morphological features of the Eustachian tube (ET) between patients with cleft lip and palate (CL/P) and normal controls using cone-beam computed tomography (CBCT). CBCT images of 51 CL/P patients (28 males and 23 females, mean age: 18.5 ± 8.0 years) and a control group of 52 patients (22 males and 30 females, mean age: 25.23 ± 10.65 years) were retrospectively evaluated. The Eustachian tube angle (ETA), Eustachian tube length (EL), and auditory tube angle (ATA) were measured on CBCT images. The ETA, EL, and ATA in the CL/P and normal control groups were 30.4 ± 6.2 and 36.7 ± 7.5°; 24.7 ± 3.7 and 27.7 ± 4.3 mm; and 142.4 ± 7.8 and 136.3 ± 4.1°, respectively. All between-group differences were statistically significant (all P < 0.05). There were no significant between-gender differences in either group (all P > 0.05). Continuous variables were compared using the Mann-Whitney U-test. The morphological features of the ET, measured via multiplanar reconstruction CBCT, differed between CL/P patients and normal controls. CBCT can be used to evaluate ET morphological features.

Hearing Thresholds in Young Children With Otitis Media With Effusion With and Without Cleft Palate

Objective:

To investigate hearing thresholds in children born with cleft palate and in children with otitis media with effusion but no cleft palate.

Design:

Prospective longitudinal group comparison study.

Setting:

University hospital.

Participants:

Sixteen children born with nonsyndromic cleft palate with or without cleft lip (CP±L) and 15 age-matched children with otitis media with effusion (OME) but without cleft.

Main Outcome Measures:

Hearing was tested at repeated occasions beginning with neonatal auditory brainstem response (ABR) at 1-4 months of age, and age-appropriate hearing tests from 9 to 36 months of age.

Results:

The median ABR thresholds in both groups were elevated but did not differ significantly. At 12 months of age, the median 4 frequency averages at 500-1000-2000-4000 Hz (4FA) were indicative of mild hearing loss but significantly better in the CP±L-group than in the group without cleft ( P < .01). There were no significant group-wise differences regarding the median 4FA at 24 and 36 months of age, and at 36 months, the median 4FA were normal in both groups. Both groups exhibited a significant improvement over time from the neonatal ABR thresholds to the 4FA at 36 months (CP±L-group P < .05; without CP±L-group P < .01).

Conclusion:

The hearing loss in children with CP±L was not more severe than among children with OME but without cleft palate; rather, at 12 months of age, the thresholds were significantly better in the CP±L-group than those in the group without cleft. The air conduction thresholds improved with age in both groups.

Cleft lip and palate associated hearing loss in Brazilian children

INTRODUCTION

Cleft lip and palate children have chronic otitis media related to Eustachian Tube dysfunction and associated conductive hearing loss. In this group of children, communicative skill development limitations, in association with orofacial aesthetics and functional disorders, can lead to behavioral, educational and social problems.

METHODS

We evaluated the minimum hearing threshold and the air-bone gap (ABG) in a range from 500 to 4000 Hz for 4-14 years old cleft lip and palate children (CLPC). This cross-sectional study took place in a multiprofessional tertiary care center and involved 89 CLPC with bilateral or unilateral postforamen or transforamen malformation, divided into two groups: those aged 4-7 and 8-14 years. The hearing tests of 89 children were evaluated: 53 (group I) aged from 4 to 7 years (67.9% male) and 36 (group II) aged from 8 to 14 years (55.6% female).

RESULTS

The minimum hearing threshold 500-4 KHz mean (MHT 500-4 KHz) was 19.4 dB for all children. MHT 500-4 KHz was 21.2 dB and 17.5 dB respectively for the group I and group II. Both groups demonstrated a minimum hearing threshold of up to 70 dB at certain frequencies. The global ABG 500-4 KHz average was 16.6 dB (SD 12.5): 19.7 dB (SD 12.9) in group I and 13.2 dB (SD 11.1) in group II.

CONCLUSION

The worst hearing thresholds were found in children of 4-7 years old: 21.2 dB MHT 500-4 KHz and 19.7 ABG 500-4 KHz, what is a disadvantage for them, as the normal hearing thresholds are up to 15 dB. The children of 8-14 years old had MHT 500-4 KHz of 17.5 dB, and ABG 500-4KHZ OF 13.2 with up to 70 dB of hearing loss.

Presentation and eustachian tube function test results in children evaluated at a specialty clinic

OBJECTIVES/HYPOTHESIS

Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET-specific or sinus balloons around the world and off-label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children.

STUDY DESIGN

Retrospective cross-sectional study.

METHODS

This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable.

RESULTS

Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%).

CONCLUSIONS

ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing.

LEVEL OF EVIDENCE

4 Laryngoscope, 129:1218-1228, 2019.

Otologic, audiometric and speech findings in patients undergoing surgery for cleft palate

BACKGROUND

Although considerable progress has been made in the last 30 years in the treatment of cleft palate (CP), a multidisciplinary approach combining examinations by a paediatrician, maxillofacial surgeon, otolaryngologist and speech and language pathologist followed by surgical operation is still required. In this work, we performed an observational cross-sectional study to determine whether the CP grade or number of ventilation tubes received was associated with tympanic membrane abnormalities, hearing loss or speech outcomes.

METHODS

Otologic, audiometric, tympanometric and speech evaluations were performed in a cohort of 121 patients (children > 6 years) who underwent an operation for CP at the Vall d'Hebron Hospital, Barcelona from 2000 to 2014.

RESULTS

The most and least frequent CP types evaluated according to the Veau grade were type III (55.37%) and I (8.26%), respectively. A normal appearance of the membrane was observed in 58% individuals, of whom 55% never underwent ventilation ear tube insertion. No statistically significant associations were identified between the CP type and number of surgeries for insertion of tubes (p = 0.820). The degree of hearing loss (p = 0.616), maximum impedance (p = 0.800) and tympanic membrane abnormalities indicative of chronic otitis media (COM) (p = 0.505) among examined patients revealed no statistically significant association with the grade of CP. However, an association was identified between hypernasality and the grade of CP (p = 0.053), COM (p = 0.000), hearing loss (p = 0.000) and number of inserted ventilation tubes.

CONCLUSION

Although the placement of tympanic ventilation tubes has been accompanied by an increased rate of COM, it is still important to assess whether this is a result of the number of ventilation tubes inserted or it is intrinsic to the natural history of middle ear inflammatory disease of such patients. Our results do not support improvements in speech, hearing, or tympanic membrane abnormalities with more aggressive management of COM with tympanostomy tubes.

Internationally adopted children with cleft lip and/or cleft palate: Middle ear findings and hearing during childhood

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.

Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate

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.

Hearing thresholds and ventilation tube treatment in children with unilateral cleft lip and palate

OBJECTIVE

Children with cleft lip and palate have a high prevalence of otitis media with effusion (OME) which is often associated with a fluctuating, conductive hearing loss in the low and mid-frequencies and a risk for permanent hearing loss in the higher frequencies. Although common, there is no consensus on the treatment of OME with ventilation tubes. The aim of this study is to document if the risk for permanent hearing loss and acquired cholesteatoma increases due to treatment with ventilation tubes (VT treatments) during childhood in a group of children with cleft lip and palate.

METHODS

A retrospective medical chart review of 33 children (25 boys and 8 girls) born with unilateral cleft lip and palate (UCLP) was completed. Audiological data (results of hearing sensitivity tests, the total number of hearing tests, and number of VT treatments) were extracted from medical records from when the children were 4-7 and >7-10 years of age.

RESULTS

The hearing thresholds in the speech frequencies improved with age (p < 0,05) but a minority of the children continued to present with elevated hearing thresholds in the higher frequencies at >7-10 years of age. There were no significant correlations between number of VT treatments and hearing thresholds at >7-10 years. Four of the 33 children presented with complications: two children exhibited perforations of the ear drum (6.1%) and two children developed unilateral cholesteatoma (6.1%).

CONCLUSION

In the current study, the hearing sensitivity of children with cleft lip and palate improved with age. However, this improvement was not seen in the higher frequencies. Twelve percent of the children experienced complications following VT treatments. Due to these complications, it is recommended that all children with cleft palate should have routine follow-ups by an ENT doctor and audiologist. As part of the routine follow-up care, hearing assessments should be performed before and after VT treatments.

Impact of pharyngofixation in cleft palate repair surgery on the development of chronic adhesive otitis media

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.

Hearing sensitivity in adults with a unilateral cleft lip and palate after two-stage palatoplasty

OBJECTIVE

To evaluate long-term hearing and middle ear status in patients treated for a unilateral complete cleft lip and palate (UCLP) by two-stage palatoplasty.

METHODS

Forty-nine UCLP patients aged 17 years and older were included in this retrospective study. Patients were invited for a multidisciplinary long-term follow-up of their treatment at a tertiary center for craniofacial surgery in the Netherlands. ENT assessment included tympanometry and pure-tone audiometry. Medical files were searched for medical and surgical history.

RESULTS

In total, 19.4% of the patients had significant long-term hearing loss (PTA > 20 dB), comprising conductive hearing loss in 21.5% of the patients. In the majority (70%), this hearing loss was more pronounced at higher frequencies. In 25% the high fletcher index showed hearing thresholds above 20 dB. Ventilation tubes were placed at least once in 78.7% of the patients. The frequency of tube insertion was positively correlated with the incidence of reduced tympanic compliance (tympanogram type B) and the need for a pharyngoplasty.

CONCLUSION

The present study reports long-term hearing outcomes in UCLP patients with hard palate closure at 3 years of age. Persistent hearing loss was observed in 19.4% of our patients (PTA > 20 dB), mainly at the higher frequencies. Ventilation tube placement was associated with reduced tympanic compliance and higher risk on hearing loss (PTA air conduction). Our high incidence of velopharyngeal incompetence during early childhood, which is likely associated with Eustachian tube dysfunction, might have contributed to these results.

Factors contributing to hearing impairment in patients with cleft lip/palate in Malaysia: A prospective study of 346 ears

OBJECTIVE

To determine the factors contributing towards hearing impairment in patients with cleft lip/palate.

METHOD

A prospective analysis was conducted on 173 patients (346 ears) with cleft lip and palate (CL/P) who presented to the combined cleft clinic at University Malaya Medical Centre (UMMC) over 12 months. The patients' hearing status was determined using otoacoustic emission (OAE), pure tone audiometry (PTA) and auditory brainstem response (ABR). These results were analysed against several parameters, which included age, gender, race, types of cleft pathology, impact and timing of repair surgery.

RESULTS

The patients' age ranged from 1-26 years old. They comprised 30% with unilateral cleft lip and palate (UCLP), 28% with bilateral cleft lip and palate (BCLP), 28% with isolated cleft palate (ICP) and 14% with isolated cleft lip (ICL). Majority of the patients (68.2%) had normal otoscopic findings. Out of the 346 ears, 241 ears (70%) ears had passed the hearing tests. There was no significant relationship between patients' gender and ethnicity with their hearing status. The types of cleft pathology significantly influenced the outcome of PTA and ABR screening results (p < 0.001). There was no significant difference between the repaired and unrepaired cleft groups and the outcome of hearing tests. However, hearing improvement occurred when palatal repair was performed at the age of <1year old (OR = 2.37, CI 1.2 = 4.6, p = 0.01).

CONCLUSION

Majority of the cleft patients had normal hearing (70%). Hearing threshold varied significantly between the different types of cleft pathology. Surgery conferred no significant impact on the hearing outcome unless surgery was performed at the age of <1 year old.

Palatoplasty decreases the re-insertion rate of middle ear ventilation tube in cleft palate children - A population-based birth cohort study

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).

The forced-response test does not discriminate ears with different otitis media expressions

OBJECTIVES/HYPOTHESIS

Test the hypothesis that the eustachian tube (ET) function measured using standard manometric test methods is different between groups of ears with tympanostomy tubes inserted for recurrent acute otitis media (RAOM) and for chronic otitis media with effusion (COME).

STUDY DESIGN

A cross-sectional study of ET function in populations of young children with different otitis media expressions.

METHODS

The results for forced-response testing of ET function were compared using a general linear model between 37 ears of 26 children and 34 ears of 26 children, aged 3 and 4 years, with ventilation tubes inserted for COME and RAOM, respectively.

RESULTS

There were no significant between-group differences in either the active measure of ET opening function, dilatory efficiency, or in the passive measures reflecting the magnitude of the forces that tend to hold the ET lumen closed, the opening and closing pressures, and passive trans-ET conductance.

CONCLUSIONS

The results do not support the hypothesis that ET closing forces are less in ears with RAOM when compared to ears with COME, and from the results of earlier studies, ears without disease. Both groups were characterized by a low ET opening efficiency (referenced to ears of adults with no disease history). Because both disease expressions present the same pattern of ET dysfunction, other factors are required to explain why a subset of ears with that type of dysfunction develop RAOM, as opposed to the default expression of COME.

LEVEL OF EVIDENCE

2b

Otitis media with effusion in children with cleft lip and palate: a narrative review

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.

Reproducibility of the forced response test in children with chronic otitis media with effusion

HYPOTHESIS

Eustachian tube function is stable over time in children with ventilation tubes for chronic otitis media with effusion.

BACKGROUND

Clinical studies report that Eustachian tube function tests in patients with a persistent tympanic membrane perforation predict the success of myringoplasty, and those in patients with ventilation tubes for chronic otitis media predict disease recurrence after the tubes become nonfunctional. In those studies, Eustachian tube function was usually tested only once, which presumes a semi-stable basal level of function for greatest diagnostic and prognostic usefulness. We investigated the stability of repeated measurements of Eustachian tube function using the forced response test.

METHODS

Thirty-nine children aged 36 to 83 months with bilateral ventilation tubes for chronic otitis media with effusion were evaluated using the forced response test 3 times at 3- to 4-month intervals. The variability across test sessions in the Eustachian tube opening pressure, closing pressure, and dilatory efficiency was estimated using regression/correlation analyses.

RESULTS

For all test parameters, the between-session and between-ear correlation coefficients were significant, but the shared variance in the parameters among test sessions and between ears at the same test session was relatively low. The average slope for each parameter as a function of the time with a ventilation tube was zero.

CONCLUSION

The low between-test shared variance for the test parameters raises questions as to whether a single forced response test captures sufficient information to accurately diagnose the cause of any dysfunction or to predict with high specificity and sensitivity future disease experience or surgical results.