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Maina G, Pollock D, Lockwood C, Cook L, Ooi E. Managing Chronic otitis media with Effusion in Children with non-Syndromic Cleft Palate: Short-Term Ventilation Tubes Versus Surveillance. Cleft Palate Craniofac J 2024; 61:905-916. [PMID: 36600676 DOI: 10.1177/10556656221148368] [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] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of short-term ventilation tubes compared to surveillance on conductive hearing loss in children with non-syndromic orofacial clefting involving the muscular palate. INTRODUCTION Chronic otitis media with effusion is a common finding in children with cleft palate. The accepted convention is insertion of short-term ventilation tubes at the time of palate repair, but some centres are choosing conservative management. Each approach has its advantages but there is currently no consensus on the most appropriate management in children with non-syndromic cleft palate. INCLUSION CRITERIA Children <18 years with cleft lip and palate, or isolated cleft palate, not associated with a genetic syndrome, who have been diagnosed with chronic otitis media with effusion. METHODS A systematic search of MEDLINE, CINAHL, Embase and Scopus databases was conducted. Grey literature searches were conducted through Central Register of Controlled Trials, Clinicaltrials.gov and ProQuest. Two reviewers screened the studies, conducted critical appraisal, assessed the methodological quality, and extracted the data. Where possible, studies were pooled in statistical meta-analysis with heterogeneity being assessed using the standard Chi-squared and I2 tests. RESULTS Four studies met the inclusion criteria but were of low quality with a moderate risk of bias. Only data on hearing thresholds could be pooled for analysis which found no statistically significant difference. Other outcomes were presented in narrative form. Certainty of evidence for all outcomes was deemed low to very low using GRADE criteria. CONCLUSIONS No definitive conclusions can be drawn regarding most effective management at improving conductive hearing loss. Missing data and inconsistent reporting of outcomes limited capacity for pooled analysis.
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Affiliation(s)
- Grace Maina
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Danielle Pollock
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Lachlan Cook
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Eng Ooi
- Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Impact of a Modified Restoration of Tensor Veli Palatini on Hearing and Middle Ear Function in Cleft Palate Children-a Retrospective Study. J Craniofac Surg 2022; 34:e259-e263. [PMID: 36728970 PMCID: PMC10128907 DOI: 10.1097/scs.0000000000009148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/26/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Many children with cleft palate also exhibit hearing loss and middle ear dysfunction, which could last for years. There are still arguments on how to treat this problem. This study aimed to evaluate the impact of a modified restoration of tensor veli palatine (TVP) on hearing and middle ear function in the cleft palate children. METHODS This retrospective study was completed using records of the cleft palate children who received surgery in Peking Union Medical College Hospital from May 2013 to December 2020. They were divided into 2 groups: Group 1: children who received cleft palate surgery without specific restoration of TVP; Group 2: children who received palate surgery with a specific TVP restoration technique. Perioperative information was collected. The conductive auditory brainstem response and the 226-Hz tympanometry before and after the cleft surgery were compared intragroup and intergroup. RESULTS Totally 42 children were included in this study, 21 children in each group. There were no significant differences considering clinical characteristics between the 2 groups. The modified TVP restoration didn't increase operation time or complication compared with no TVP restoration. Statistically, neither the auditory brainstem response air conduction hearing thresholds nor the 226-Hz tympanometry results had significant differences between the 2 groups after the surgery. CONCLUSIONS This modified restoration of TVP was not time-consuming and did not increase complications. The beneficial effect of the modified TVP restoration on the hearing or the middle ear function of cleft palate children was uncertain around 6 months after surgery compared with no restoration.
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Nomura Y, Oshima H, Nomura K, Kakuta R, Ikeda R, Hirano AK, Ota J, Kawase T, Katori Y. Outcome of the 'waiting until spontaneous extrusion' strategy for long-term tympanostomy tube placement in children with cleft palate. Acta Otolaryngol 2022; 142:248-253. [PMID: 35451931 DOI: 10.1080/00016489.2022.2041210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) in children with cleft palate (CP) is known to be refractory to treatment and most of these patients undergo surgery for ventilation tube (VT) placement. OBJECTIVES To identify the outcomes of children with CP using long-term VT with a 'waiting until spontaneous extrusion' strategy. MATERIAL AND METHODS We retrospectively reviewed the medical records of all children with CP who visited our department from December 2016 to November 2017 and who received long-term VT placement in our department. Risk factors related to residual perforation and recurrence of OME were analyzed. RESULTS A total of 106 children were included in this study. Our statistical analysis of 94 ears followed for more than three months after VT loss revealed that longer VT placement was associated with residual perforation, and shorter VT placement was associated with OME recurrence. Although a longer duration of VT placement was associated with an increased rate, extremely long-term VT placement was not associated with residual perforation, as expected. Half of the VTs were spontaneously extruded at 40 months after insertion. CONCLUSIONS AND SIGNIFICANCE Long-term VT insertion using a waiting until spontaneous extrusion strategy is a potential option for children with CP.
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Affiliation(s)
- Yuri Nomura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Sen-En Rifu Otological Surgery Center, Miyagi, Japan
| | | | - Kazuhiro Nomura
- Department of Otolaryngology, Tohoku Kosai Hospital, Sendai, Japan
| | - Risako Kakuta
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Iwate prefectural Iwai hospital, Iwate, Japan
| | - Ai Kawamoto Hirano
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Ota
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Laboratory of Rehabilitative Auditory Science, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Guerra MS, Franchi V, Novaes BA, Favero M, Pirana S. Cleft lip and palate: Relationship between phonological awareness and audiological characteristics in children. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2021. [DOI: 10.4103/jclpca.jclpca_45_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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Shaffer AD, Ford MD, Choi SS, Jabbour N. The Impact of Timing of Tympanostomy Tube Placement on Sequelae in Children With Cleft Palate. Cleft Palate Craniofac J 2018; 56:720-728. [DOI: 10.1177/1055665618809228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Amber D. Shaffer
- Department of Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Matthew D. Ford
- Cleft-Craniofacial Center, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA. Sukgi Choi is now with Boston Children’s Hospital, Boston, MA, USA
| | - Sukgi S. Choi
- Department of Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Noel Jabbour
- Department of Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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Garcia-Vaquero C, Mir C, Graterol D, Ortiz N, Rochera-Villach MI, LLeonart ME, Lorente J. Otologic, audiometric and speech findings in patients undergoing surgery for cleft palate. BMC Pediatr 2018; 18:350. [PMID: 30409226 PMCID: PMC6225714 DOI: 10.1186/s12887-018-1312-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 10/16/2018] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Cristina Garcia-Vaquero
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Mir
- Biomedical Research in Cancer Stem Cells, Vall d'Hebron Research Institute, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Domingo Graterol
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Nuria Ortiz
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Maria Isabel Rochera-Villach
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Matilde E LLeonart
- Biomedical Research in Cancer Stem Cells, Vall d'Hebron Research Institute, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Juan Lorente
- Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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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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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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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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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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Alencar TRR, Marques IL, Bertucci A, Prado-Oliveira R. Neurological Development of Children With Isolated Robin Sequence Treated With Nasopharyngeal Intubation in Early Infancy. Cleft Palate Craniofac J 2016; 54:256-261. [PMID: 27043650 DOI: 10.1597/14-228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The study assessed the neurodevelopment of children with isolated Robin sequence (IRS) and evaluated if children treated exclusively with nasopharyngeal intubation (NPI) present delay in neurological development. The prospective and cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Children with IRS were divided into two groups according to the type of treatment in early infancy: 38 were treated with NPI (more severe cases) and 24 with postural treatment (less severe cases). Regarding interventions, children were assessed at 2 to 6 years of age using the Denver II Developmental Screening Test (Denver II) and Neurological Evolutionary Examination (NEE). According to Denver II, 73.7% in the NPI group and 79.2% in the postural group presented normal development. This result was similar to the results of different studies in the literature with typical population. Considering all areas of development, there were no significant differences in Denver II between the NPI and postural groups (P = .854). In the NPI group, 89.5% of children and 87.5% in the postural group presented normal development in NEE. Language was the most affected area, as 18.4% and 20.8% of children in NPI and postural group, respectively, presented risk for delay in the Denver II. The increased risk for delay in language area was probably due to anatomical conditions of the muscles involved in speech, and to hearing oscillations, as 47.4% in NPI group and 58.3% in postural group underwent myringotomy. IRS treated with NPI had neurological development similar to those in less severe cases. Children treated exclusively with NPI did not present delay in neurological development.
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15
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Middle ear findings and need for ventilation tubes among pediatric cleft lip and palate patients in northern Finland. J Craniomaxillofac Surg 2016; 44:460-4. [DOI: 10.1016/j.jcms.2016.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022] Open
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16
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Guerrero-Abello P, Ariza-Araujo Y, Caycedo-García DJ, Pachajoa H. [The need for clinical guidelines for the comprehensive management of patients with cleft lip and palate]. Rev Salud Publica (Bogota) 2016; 18:82-94. [PMID: 28453156 DOI: 10.15446/rsap.v18n1.41884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 06/05/2015] [Indexed: 11/09/2022] Open
Abstract
Objective To identify clinical guidelines for the treatment of cleft lip and / or palate in children under one year of age, published in Colombia and internationally. Method A search was conducted in three databases: PubMed, Lilacs and Scielo with the terms "guideline cleft lip and palate", "protocols cleft lip and palate", "guía clínica labio paladar fisurado", "guía de manejo labio paladar fisurado" and "guía labio paladar hendido". In addition to this, we consulted the websites of all pediatric hospitals in Colombia. Results 190 papers were found, of which 96 were not related to the population or focused on treatment, 84 were disciplinary, 8 interdisciplinary and only two were clinical guidelines. Conclusions There are few published guidelines and there is a lack of unified criteria. This gives rise to numerous forms of intervention and the creation of interdisciplinary teams. Therefore, there is a need to reach a consensus regarding the therapeutic approach in order to create treatment protocols based on evidence with quality standards.
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Affiliation(s)
| | | | | | - Harry Pachajoa
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia,
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17
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Mullins RA, Guerin SR, Pratschke KM. Use of a split-thickness soft palate hinged flap and bilateral buccal mucosal rotation flaps for one-stage repair of a bilateral hypoplastic soft palate in a dog. J Am Vet Med Assoc 2016; 248:91-5. [PMID: 26684096 DOI: 10.2460/javma.248.1.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 14-week-old 8.5-kg (18.7-lb) sexually intact female Springer Spaniel was evaluated because of chronic rhinitis with bilateral mucopurulent nasal discharge. The dog had a history since birth of sneezing and oronasal reflux of food and liquid. CLINICAL FINDINGS Oral examination under anesthesia revealed a short, incompletely formed soft palate with bilateral clefts. A pseudouvula was not a prominent feature of the condition in this dog. TREATMENT AND OUTCOME The dog underwent 1-stage reconstruction of the soft palate by means of a split-thickness soft palate hinged flap and bilateral buccal mucosal rotation flaps. Long-term follow-up obtained 3 years after surgery revealed the dog to be in good general health, with resolution of oronasal reflux; however, occasional episodes of mild sneezing and nasal discharge persisted. Oral examination under sedation revealed attenuation of the bilateral clefts; however, a normal soft palate length was not achieved. CLINICAL RELEVANCE Compared with previously described techniques, this technique offered the possibility of 1-stage reconstruction of the soft palate in dogs, rather than having 2 staged procedures performed, and a robust tissue combination that was expected to be less prone to trauma. This technique may be particularly suitable for affected dogs where a pseudouvula is not a prominent feature and appears to be applicable to a variety of skull morphologies. Owners should be made aware that the absence of normal palatine muscle within the reconstructed palate may affect function, but even where normal function is not regained, a good quality of life with minimal clinical signs may be achieved.
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18
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Ezzi OE, Herzog G, Broome M, Trichet-Zbinden C, Hohlfeld J, Cherpillod J, de Buys Roessingh AS. Grommets and speech at three and six years in children born with total cleft or cleft palate. Int J Pediatr Otorhinolaryngol 2015; 79:2243-7. [PMID: 26545794 DOI: 10.1016/j.ijporl.2015.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Grommets may be considered as the treatment of choice for otitis media with effusion (OME) in children born with a cleft. But the timing and precise indications to use them are not well established. The aim of the study is to compare the results of hearing and speech controls at three and six year-old in children born with total cleft or cleft palate in the presence or not of grommets. METHODS This retrospective study concerns non syndromic children born between 1994 and 2006 and operated for a unilateral cleft lip palate (UCLP) or a cleft palate (CP) alone, by one surgeon with the same schedule of operations (Malek procedure). We compared the results of clinical observation, tympanometry, audiometry and nasometry at three and six year-old. The Borel-Maisonny classification was used to evaluate the velar insufficiency. None of the children had preventive grommets. The Fisher Exact Test was used for statistical analysis with p<0.05 considered as significant. RESULTS Seventy-seven patients were analyzed in both groups. Abnormal hearing status was statistically more frequent in children with UCLP compared to children with CP, at three and six years (respectively, 80-64%, p<0.03 and 78-60%, p<0.02), with the use of grommets at six years in 43% of cases in both groups. Improvement of hearing status between three and six year-old was present in 5% of children with UCLP and 9% with CP, without the use of grommets. CONCLUSION The use of grommets between three and six year-old was not associated to any improvement of hearing status or speech results children with UCLP or with CP, with a low risk of tympanosclerosis. These results favor the use of grommets before the age of three, taking into account the risk of long term tympanosclerosis.
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Affiliation(s)
- Oumama El Ezzi
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Georges Herzog
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Martin Broome
- Department of Otolaryngology, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Chantal Trichet-Zbinden
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Judith Hohlfeld
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Jacques Cherpillod
- Department of Otolaryngology, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland
| | - Anthony S de Buys Roessingh
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
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Kuşcu O, Günaydın RÖ, İcen M, Ergün O, Kulak Kayikci ME, Yılmaz T, Özgür FF, Akyol MU. The effect of early routine grommet insertion on management of otitis media with effusion in children with cleft palate. J Craniomaxillofac Surg 2015; 43:2112-5. [PMID: 26545930 DOI: 10.1016/j.jcms.2015.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/07/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim of the study is to compare long term otoscopic and audiological findings of cleft palate patients with or without early grommet insertion. METHODS Cleft palate patients followed-up in Hacettepe University between 2008 and 2013 were included in the study. Age, gender, cleft types and palate surgery data, grommet tube insertion history and otological - audiological evaluations of the patients were recorded. Patients were evaluated in three groups according to grommet insertion history: A-early routine grommet insertion, B-grommet insertion during follow-up, C-no grommet insertion. Otological and audiological findings were compared. RESULTS There were 154 patients in the study, with a median age of 7.7 years. There were 67 patients in group A (43.5%), 22 patients in group B (14.3%) and 65 patients in group C (42.2%). OME was identified significantly higher in group A and normal otoscopic examination findings were higher in group C. Complications showed a higher rate than other otoscopic findings in group B patients. There was no significant difference for any frequencies in between the groups in terms of mean air-bone gap (ABG) values. There were 20 grade I, 25 grade II, 77 grade III and 32 grade IV patients in the study according to the Veau classification. CONCLUSION Prophylactic grommet insertion may not be applied as some cleft palate patients with no OME. Wait and see protocol can be recommended for these patients, and they should be followed-up up closely to avoid complications. If the effusion does not recover or tympanic membrane changes occur in follow-up, grommet insertion should be considered.
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Affiliation(s)
- Oğuz Kuşcu
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
| | | | - Mehtap İcen
- Hacettepe University, Department of Otorhinolaryngology, Audiology and Speech Pathology Unit, Ankara, Turkey.
| | - Onur Ergün
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
| | - Mavis Emel Kulak Kayikci
- Hacettepe University, Department of Otorhinolaryngology, Audiology and Speech Pathology Unit, Ankara, Turkey.
| | - Taner Yılmaz
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
| | - Fatma Figen Özgür
- Department of Plastic and Reconstructive Surgery, Hacettepe University Medical School, Ankara, Turkey.
| | - Mehmet Umut Akyol
- Hacettepe University, Department of Otorhinolaryngology, Ankara, Turkey.
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Smallridge J, Hall AJ, Chorbachi R, Parfect V, Persson M, Ireland AJ, Wills AK, Ness AR, Sandy JR. Functional outcomes in the Cleft Care UK study--Part 3: oral health and audiology. Orthod Craniofac Res 2015; 18 Suppl 2:25-35. [PMID: 26567853 PMCID: PMC4950029 DOI: 10.1111/ocr.12110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare oral health and hearing outcomes from the Clinical Standards Advisory Group (CSAG, 1998) and the Cleft Care UK (CCUK, 2013) studies. SETTING AND SAMPLE POPULATION Two UK-based cross-sectional studies of 5-year-olds born with non-syndromic unilateral cleft lip and palate undertaken 15 years apart. CSAG children were treated in a dispersed model of care with low-volume operators. CCUK children were treated in a centralized, high volume operator system. MATERIALS AND METHODS Oral health data were collected using a standardized proforma. Hearing was assessed using pure tone audiometry and middle ear status by otoscopy and tympanometry. ENT and hearing history were collected from medical notes and parental report. RESULTS Oral health was assessed in 264 of 268 children (98.5%). The mean dmft was 2.3, 48% were caries free, and 44.7% had untreated caries. There was no evidence this had changed since the CSAG survey. Oral hygiene was generally good, 96% were enrolled with a dentist. Audiology was assessed in 227 of 268 children (84.7%). Forty-three per cent of children received at least one set of grommets--a 17.6% reduction compared to CSAG. Abnormal middle ear status was apparent in 50.7% of children. There was no change in hearing levels, but more children with hearing loss were managed with hearing aids. CONCLUSIONS Outcomes for dental caries and hearing were no better in CCUK than in CSAG, although there was reduced use of grommets and increased use of hearing aids. The service specifications and recommendations should be scrutinized and implemented.
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Affiliation(s)
- J Smallridge
- South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK
- Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK
| | - A J Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Chorbachi
- North Thames Cleft Centre, Great Ormond Street Hospital for Children and Broomfield Hospital, London, UK
| | - V Parfect
- East of England Cleft Network, Audiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Persson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - A J Ireland
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A K Wills
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - A R Ness
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - J R Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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21
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Lithovius RH, Lehtonen V, Autio TJ, Harila V, Anttonen V, Sándor GK, Ylikontiola LP. The association of cleft severity and cleft palate repair technique on hearing outcomes in children in northern Finland. J Craniomaxillofac Surg 2015; 43:1863-7. [PMID: 26421466 DOI: 10.1016/j.jcms.2015.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/29/2015] [Accepted: 08/18/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The consequences of cleft lip and palate include scaring, dental malformations, tooth misalignment, speech problems, and hearing loss. Otitis media with effusion causing hearing loss is a problem for many cleft palate patients. METHODS This study examines the association among cleft severity, palate repair technique, and hearing outcomes in children from northern Finland with clefts, aged 3-9 years. The study included 90 cleft patients who were treated at the Oulu University Hospital Cleft Lip and Palate Center between 1998 and 2011. The severity of the cleft, the surgical technique used to repair the palate, audiogram configuration data, and the need for ventilation tube placement were determined retrospectively from patient records. RESULTS Only 3.3% of cleft patients had an abnormal pure tone average hearing threshold representing abnormal hearing. Neither the surgical technique used to repair the cleft palate nor the severity of the cleft was a significant factor related to hearing loss or to the number of ventilation tubes required. Hearing improved significantly with increasing age over a span of 6 years. CONCLUSIONS Continuous follow-up with proactive placement of ventilation tubes before or at the time of palatoplasty results in hearing outcomes in cleft children that are similar to those reported in non-cleft children.
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Affiliation(s)
- Riitta H Lithovius
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Ville Lehtonen
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland
| | - Timo J Autio
- Department of Otolaryngology, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Virpi Harila
- Department of Oral Development and Orthodontics, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Vuokko Anttonen
- Department of Cariology, Paedodontics and Endodontology, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - George K Sándor
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.
| | - Leena P Ylikontiola
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
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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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Kuo CL, Tsao YH, Cheng HM, Lien CF, Hsu CH, Huang CY, Shiao AS. Grommets for otitis media with effusion in children with cleft palate: a systematic review. Pediatrics 2014; 134:983-94. [PMID: 25287451 DOI: 10.1542/peds.2014-0323] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE No consensus has yet been reached with regard to the link between otitis media with effusion (OME), hearing loss, and language development in children with cleft palate. The objective of this study was to address the effectiveness of ventilation tube insertion (VTI) for OME in children with cleft palate. METHODS A dual review process was used to assess eligible studies drawn from PubMed, Medline via Ovid, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and reference lists between 1948 and November 2013. Potentially relevant papers were selected according to the full text of the articles. Relevant data were extracted onto a data extraction sheet. RESULTS Nine high- or moderate-quality cohort studies were included in this study. VTI was administered in 38% to 53% of the OME cases, and more severe cases appeared more likely to undergo VTI. Compared with conservative forms of management (eg, watchful waiting), VTI has been shown to be beneficial to the recovery of hearing in children with cleft palate and OME. A growing body of evidence demonstrates the benefits of VTI in the development of speech and language in children with cleft palate and OME. These children face a higher risk of complications than those undergoing conservative treatments, the most common of which are eardrum retraction and tympanosclerosis, with an incidence of ∼ 11% to 37%. CONCLUSIONS This review provides evidence-based information related to the selection of treatment for OME in children with cleft palate. Additional randomized controlled trials are required to obtain bias-resistant evidence capable of reliably guiding treatment decisions. The conclusions in this review are based on underpowered cohort studies and very-low-strength evidence.
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Affiliation(s)
- Chin-Lung Kuo
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology, Institute of Brain Science, and Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China; Department of Otolaryngology, National Defense Medical Center, Taipei, Taiwan, Republic of China; and
| | - Yuan-Heng Tsao
- Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, Republic of China; Department of Otolaryngology, National Defense Medical Center, Taipei, Taiwan, Republic of China; and
| | - Hao-Min Cheng
- Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
| | - Chiang-Feng Lien
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology
| | - Chyong-Hsin Hsu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China
| | - Chii-Yuan Huang
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology
| | - An-Suey Shiao
- Departments of Otolaryngology-Head and Neck Surgery, and Department of Otolaryngology, Department of Otolaryngology, National Defense Medical Center, Taipei, Taiwan, Republic of China; and
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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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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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Spilsbury K, Ha JF, Semmens JB, Lannigan F. Cholesteatoma in cleft lip and palate: a population-based follow-up study of children after ventilation tubes. Laryngoscope 2013; 123:2024-9. [PMID: 23737350 DOI: 10.1002/lary.23753] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/24/2012] [Accepted: 09/03/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the association of cleft conditions and the development of secondary cholesteatoma following middle ear ventilation tube insertion (MEVTI) in children. STUDY DESIGN A retrospective cohort study of all children born after 1980 who underwent at least one MEVTI in a Western Australian hospital from 1980 to 2009 using administrative health data. METHODS The timing and number of MEVTIs, adenoidectomy, type of cleft conditions and cholesteatoma were identified along with demographic variables. Flexible parametric proportional hazards models and hazard functions using age as a time scale were used to estimate the relative rate of developing cholesteatoma. RESULTS There were 56,949 children who underwent at least one MEVTI during the study period. There were 869 (1.5%) children who also had a diagnosis of a cleft condition. Overall, 594 (1.0%) children developed a secondary cholesteatoma. After taking length of follow-up into account, 6.9% (95% confidence interval [CI], 5.0-9.6) of children with cleft conditions developed cholesteatoma by 18 years of age compared to 1.5% (95% CI, 1.3-1.6) of children without cleft conditions. After adjusting for demographic and clinical variables, children with cleft conditions developed cholesteatoma 7.5 (95% CI, 3.8-18.2) times faster after first MEVTI compared to children without cleft conditions, although by the third MEVTI this difference was no longer statistically significant (P = .257). The rate of developing cholesteatoma in 2005 to 2009 was 0.5 (95% CI, 0.3-0.8) times that of 1980 to 1990. CONCLUSIONS Children with cleft conditions are at increased risk of developing cholesteatoma compared to other children who had one or two MEVTIs, although the overall rate of cholesteatoma is declining.
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Affiliation(s)
- Katrina Spilsbury
- Centre for Population Health Research, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
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Woodbridge NT, Baines EA, Baines SJ. Otitis media in five cats associated with soft palate abnormalities. Vet Rec 2012; 171:124. [DOI: 10.1136/vr.100720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- N. T. Woodbridge
- Department of Surgery; University of Nottingham and Dick White Referrals; London Road, Suffolk CB8 0UH, Six Mile Bottom Cambridgeshire UK
| | - E. A. Baines
- Willows Veterinary Centre and Referral Service; Highlands Road, Shirley Solihull West Midlands B90 4NH UK
| | - S. J. Baines
- Department of Surgery; University of Nottingham and Dick White Referrals; London Road, Suffolk CB8 0UH, Six Mile Bottom Cambridgeshire UK
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A review of hearing loss in cleft palate patients. Int J Otolaryngol 2012; 2012:548698. [PMID: 22518157 PMCID: PMC3299272 DOI: 10.1155/2012/548698] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/24/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Cleft palate is associated with recurrent otitis media with effusion and hearing loss. This study analysed the way these patients' hearing is managed in Alder Hey Children's Hospital. Method. A retrospective audit was carried out on cleft palate patients in Alder Hey Children's Hospital. Audiology assessment and treatment options were reviewed. Comparisons were made between the use of ventilation tubes (VTs) and hearing aids (HAs). The types of cleft, types of hearing loss, and the management output of the audiology regions were also reviewed. Results. The audiology assessments of 254 patients were examined. The incidence of VT insertion in this group of patients was 18.9%. The hearing aid incidence rate was 10.1%. The VT-related complication rate was 25.5% and the HA related complication rate was 9.1%. Conclusion. The data demonstrates that both treatments are viable, and a new protocol which combines the short term benefit of VT insertion with the lower complication rate of HA is required.
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Kwan WM, Abdullah VJ, Liu K, Van Hasselt CA, Tong MC. Otitis Media with Effusion and Hearing Loss in Chinese Children with Cleft Lip and Palate. Cleft Palate Craniofac J 2011; 48:684-9. [DOI: 10.1597/10-006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To determine the incidence of otitis media with effusion and the associated hearing loss, the rate of ventilation tube insertion, and complications of ventilation tube insertion in Chinese cleft palate patients. Design Retrospective review in a tertiary care hospital in Hong Kong. Patients A total of 104 consecutive patients with cleft lip and/or cleft palate who were born between January 1996 and January 2006. Results The incidence of otitis media with effusion in Chinese cleft palate patients for the first 2 years after birth was 76.1%. Of these patients, 16.9% had otitis media with effusion associated with a moderate hearing loss (40 decibels hearing level [dBHL]). Approximately half (53.2%) of our patients had ventilation tube insertion. Complications including retraction, tympanosclerosis, and perforation of the tympanic membrane were found in 15.7% of all ears with otitis media with effusion and ventilation tube insertion. Conclusions The high incidence of otitis media with effusion in cleft palate infants found in this study is consistent with that reported in the Western literature. A small but significant proportion of otitis media with effusion was associated with moderate hearing loss that truly required surgical treatment. Cleft palate children are much more likely to develop otitis media with effusion than normal children, and they develop the condition at an earlier age. A protocol for the treatment of otitis media with effusion in cleft palate patients and further prospective studies are warranted.
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Affiliation(s)
- Wendy M.Y. Kwan
- Department of Otorhinolaryngology, United Christian Hospital, Shatin, Hong Kong
| | - Victor J. Abdullah
- Department of Otorhinolaryngology, United Christian Hospital, Shatin, Hong Kong
| | - Kelvin Liu
- United Christian Hospital, Shatin, Hong Kong
| | - C. Andrew Van Hasselt
- Otorhinolaryngology–Head and Neck Surgery, and Dr. Tong is Professor, Otorhinolaryngology–Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Michael C.F. Tong
- Otorhinolaryngology–Head and Neck Surgery, and Dr. Tong is Professor, Otorhinolaryngology–Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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Szabo C, Langevin K, Schoem S, Mabry K. Treatment of persistent middle ear effusion in cleft palate patients. Int J Pediatr Otorhinolaryngol 2010; 74:874-7. [PMID: 20537733 DOI: 10.1016/j.ijporl.2010.04.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 04/22/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The goals of the research project are to learn how to individualize otologic care for cleft palate patients and to be able to counsel families of children with cleft palate on the benefit of tympanostomy tubes, hearing issues and risks of multiple sets of tubes. METHODS The study is a retrospective chart review. Patients with a cleft palate with or without a cleft lip born between 1 January 2000 and 31 December 2005 referred to the Connecticut Children's Medical Center Craniofacial Department were included in the study. The patients were offered individualized ear surgery (PE tube placement) only if persistent middle ear fluid was present for over 3 months with a conductive hearing impairment. The primary outcome measures included the newborn hearing screening results, number of ear tube surgeries, and complications of PE tube insertion. RESULTS There were 86 patients with cleft palate spectrum with or without cleft lip (45 females and 41 males). Twelve had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive. By 5 years old, 84 (98%) patients received at least one set of ear tubes for persistent middle ear fluid with conductive hearing impairment, while 2 received no tubes (2%). Of those who received ear tubes, the range was 1-6 with a mean of 1.7. Twelve patients (14%) had tympanosclerosis. Eight patients (9%) had eardrum perforation. One patient had myringoincudopexy. Of the 86 patients, 12 had undocumented newborn hearing evaluations. Of the 74 evaluable results, 61 (82%) passed the newborn hearing screening, 8 (11%) failed and 5 (7%) were inconclusive. CONCLUSIONS (1) The majority of children born with cleft palate do not have middle ear fluid at birth. (2) Most children with cleft palate will likely develop persistent middle ear fluid with conductive hearing loss. Risks of complications from ear tubes in cleft palate patients are few and manageable using standard sized ear tubes.
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Affiliation(s)
- C Szabo
- Division of Otolaryngology, Connecticut Children's Medical Center, Hartford, CT 06106, United States
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Da Silva DP, Collares MVM, Da Costa SS. Effects of Velopharyngeal Dysfunction on Middle Ear of Repaired Cleft Palate Patients. Cleft Palate Craniofac J 2010; 47:225-33. [DOI: 10.1597/09-008.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Cleft palates are strongly associated with the development of otitis media due to the anatomic and functional defect of the soft palate musculature and the associated alterations of velopharyngeal muscle insertion on tubal cartilage, or even intrinsic alterations of the cartilage, which affects eustachian tube function. This study will assess velopharyngeal muscle adequacy after palatoplasty through videonasoendoscopy and verify if there is a correlation with otologic status. Design Transversal study. Setting Otorhinolaryngology and cleft palate outpatient service of the Hospital de Clinicas de Porto Alegre (HCPA), Porto Alegre, Brazil. Patients Seventy-three patients with cleft palate or cleft lip and palate between the ages of 6 and 12 years who had already undergone palatoplasty. Interventions Videonasoendoscopy for evaluation of velopharyngeal function and videotoscopy to assess middle ear status. Main Outcome Measures Severity scale for videonasoendoscopic and videotoscopic findings. Results There was no significant correlation between the videonasoendoscopic and the videotoscopic scores in the population studied. Discussion and Conclusions Intrinsic defects of the eustachian tube cartilage and of the insertion of the velopharyngeal muscles seem to contribute to the evolution of otitis media in patients with cleft palate, in addition to the actual defect of the soft palate. There was no correlation between the severity of the otoscopic findings and the degree of velopharyngeal dysfunction.
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Affiliation(s)
- Daniela Preto Da Silva
- Universidade Federal do Rio Grande do Sul, Member of the Craniofacial Surgery Group of Hospital de Clinicas de Porto Alegre, Fellowship on Otology and Cochlear Implants of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcus Vinicius Martins Collares
- Craniomaxillofacial Surgery, Universidade Federal do Rio Grande do Sul, Head of the Craniofacial Surgery Group of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Sady Selaimen Da Costa
- Otorhinolaryngology, Universidade Federal do Rio Grande do Sul, Head of the Chronic Otitis Media Center of Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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Santos FRD, Piazentin-Penna SHA, Brandão GR. Avaliação audiológica pré-cirurgia otológica de indivíduos com fissura labiopalatina operada. REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010005000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: descrever as características audiológicas de indivíduos com fissura labiopalatina operada (FLP) e indicação de cirurgia otológica, comparando os grupos quanto ao tipo e grau da perda auditiva, bem como a curva timpanométrica. MÉTODOS: análise de 150 prontuários, ambos os gêneros, idade igual ou superior a 4 anos, FLP e indicação de cirurgia otológica, divididos em 3 grupos: I - Tubo de ventilação (TV), II - Timpanoplastia e III - Timpanomastoidectomia, analisando aspectos quanto a entrevista audiológica, audiometria tonal limiar e imitanciometria. RESULTADOS: o grupo I apresentou porcentagem maior de cirurgia bilateral (86%), o que não ocorreu nos demais grupos. Na entrevista audiológica, 83% apresentou algum tipo de queixa auditiva, sendo a mais frequente a perda auditiva (64%) com p<0,05 entre os grupos I e II; I e III. O tipo de perda auditiva de maior ocorrência foi condutivo bilateral (56%) seguido de unilateral (35%), com p<0,05 entre os grupos I e II; I e III. A perda de grau leve unilateral foi a de maior ocorrência (41%), seguida de grau leve a moderada bilateral (20%), com p<0,05 entre os três grupos. A curva timpanométrica mais frequente foi a do tipo B bilateral (39%) com p<0,05 entre os três grupos. CONCLUSÃO: a maioria dos indivíduos apresentou algum tipo de queixa na entrevista audiológica e alterações na audiometria tonal limiar e imitanciometria. A maioria dessas alterações foi compatível com problemas de orelha média, com perda auditiva do tipo condutiva, de grau leve e bilateral, independentemente da indicação cirúrgica.
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Zambonato TCDF, Feniman MR, Blasca WQ, Lauris JRP, Maximino LP. Profile of patients with cleft palate fitted with hearing AIDS. Braz J Otorhinolaryngol 2010; 75:888-92. [PMID: 20209293 PMCID: PMC9446106 DOI: 10.1016/s1808-8694(15)30555-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 10/05/2009] [Indexed: 11/13/2022] Open
Abstract
Cleft palates cause alterations in palate and lip structures, and it may also cause hearing loss because of recurrent otitis media. The appropriate treatment is controversial. It may include the prescription of antibiotics and insertion of a ventilation tube, or even otorhinolaryngological and audiological assistance, and hearing rehabilitation, with the use of an individual sound amplifier aid (ISAA). Aim To characterize the profile of individuals with cleft palate and hearing loss, users of ISAA are assisted by the center of otorhinolaryngology and speech therapy of a hospital specialized in craniofacial anomalies and hearing impairment. Retrospective Study. Materials and Methods Retrospective analysis of 131 charts of patients with corrected cleft palate and hearing loss, fitted with ISAA by the center abovementioned. Results The sample (n=131) was characterized by a prevalence of females (53%), unilateral incisive transforaminal cleft (27%), presence of associated anomalies (51%), history of alterations of the middle ear (56%) and surgery intervention (56%). Conclusion The general profile of the individuals with cleft palate and hearing loss, fitted with ISAA, was characterized by the predominance of cleft lip and palate, positive history of middle ear alterations, surgery intervention and bilateral sensorineural hearing loss.
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White RN, Hawkins HL, Alemi VP, Warner C. Soft palate hypoplasia and concurrent middle ear pathology in six dogs. J Small Anim Pract 2009; 50:364-72. [DOI: 10.1111/j.1748-5827.2009.00742.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Phua YS, Salkeld LJ, de Chalain TMB. Middle ear disease in children with cleft palate: protocols for management. Int J Pediatr Otorhinolaryngol 2009; 73:307-13. [PMID: 19091429 DOI: 10.1016/j.ijporl.2008.10.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 10/25/2008] [Accepted: 10/30/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is wide international variation in the protocols used for middle ear disease management in cleft palate patients. Ventilation tube (grommet) insertion may occur routinely at the time of palatoplasty or selectively on a separate occasion if symptomatic middle ear disease develops. The audiological and otologic outcomes of cleft palate patients were studied in a single institution over a timeframe in which both protocols were utilised. METHODS This was a retrospective study of 234 cleft palate patients who underwent palatoplasty from 1990 to 2005 at Middlemore Hospital, Auckland, New Zealand. Data on hearing loss, middle ear disease, and tympanic membrane abnormalities was collected from clinical notes. Audiological data was obtained from pure tone audiogram reports. RESULTS Forty-five patients had routine grommets inserted concurrent with palatoplasty and 189 patients were managed conservatively with selective grommet insertion if indicated. Grommets were subsequently required in 79 (41.8%) of these 189 patients. There was no difference in the incidence of persistent conductive hearing loss, but recurrent middle ear disease, tympanic membrane abnormalities, and the total number of grommet insertions were significantly higher in the routine grommet group. Poorer outcomes were noted in patients who had undergone a greater number of grommet insertions. CONCLUSION No significant deterioration in audiological outcomes and better otologic outcomes were found in cleft palate patients undergoing selective grommet insertion compared to routine grommet insertion. It is recommended that ventilation tube placement occur in patients selected on the basis of symptomatic infection or significant hearing loss.
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Affiliation(s)
- Yun Shan Phua
- Cleft and Craniofacial Surgery Service, Regional Centre for Plastic Surgery, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand.
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Ponduri S, Bradley R, Ellis PE, Brookes ST, Sandy JR, Ness AR. The Management of Otitis Media with Early Routine Insertion of Grommets in Children with Cleft Palate—A Systematic Review. Cleft Palate Craniofac J 2009; 46:30-8. [DOI: 10.1597/07-219.1] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To determine whether early routine grommet insertion in children with cleft palate has a beneficial effect on hearing and speech and language development compared with conservative management. Design: Systematic review of randomized controlled trials, controlled clinical trials, case series, and prospective and historical cohort studies. Main Outcome Measures: The main outcome measure was the effect of early routine grommet placement on the degree of conductive hearing loss. Secondary outcome measures included differences in hearing level, possible side effects, speech and language development, and quality of life. Results: We identified 368 citations for review. From a review of the titles, 34 potentially relevant papers were selected. Of these, 18 studies met our inclusion criteria, including eight case series, six historical cohort studies, three prospective cohort studies, and one randomized trial. Most studies were either small or of poor quality or both. The results of the studies were contradictory, with some studies suggesting early placement of grommets was beneficial and others reporting there was no benefit. Conclusions: There is currently insufficient evidence on which to base the clinical practice of early routine grommet placement in children with cleft palate.
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Affiliation(s)
- Sirisha Ponduri
- University of Bristol Dental School, Bristol, United Kingdom
| | - Rebecca Bradley
- University of Bristol Dental School, Bristol, United Kingdom
| | | | - Sara T. Brookes
- Health Services Research, Department of Social Medicine, University of Bristol, Bristol, United Kingdom
| | | | - Andy R. Ness
- University of Bristol Dental School, Bristol, United Kingdom
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Paquot-Le Brun C, Babin E, Moreau S, Bequignon A. Séquelles otologiques dans les fentes palatovélaires. Analyse et prise en charge. ACTA ACUST UNITED AC 2007; 108:357-68. [PMID: 17692349 DOI: 10.1016/j.stomax.2007.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 06/15/2007] [Indexed: 10/28/2022]
Abstract
As early as in 1878, medical teams managing children born with a velopalatine cleft had noted the prevalence of middle-ear pathologies largely related to anatomic and inflammatory Eustachian tube dysfunction. The aim of this study was to describe otologic sequels related to a velopalatine cleft and to suggest an adapted management. These sequels are evolving presentations of chronic serous otitis; they worsen the functional prognosis (hypoacousia) and more rarely the vital prognosis (cerebral or infectious complications of cholesteatoma). We must stress the importance of prevention: during the initial management, by Eustachian tube rehabilitation, and by ENT (Ear, Noseand Throat) follow-up allowing to prevent these sequels and to bring hearing to normal as soon as possible, so as to support cognitive development, language skills, and sociofamilial integration of the children.
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Affiliation(s)
- C Paquot-Le Brun
- Service d'ORL et de chirurgie cervicofaciale, CHU de Côte-de-Nacre, 14000 Caen, France.
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Hassan ME, Askar S. Does palatal muscle reconstruction affect the functional outcome of cleft palate surgery? Plast Reconstr Surg 2007; 119:1859-1865. [PMID: 17440366 DOI: 10.1097/01.prs.0000259185.29517.79] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study was designed to compare two-layer palatoplasty (Wardill-Kilner V-Y pushback technique) without intravelar veloplasty versus three-layer palatoplasty (Kriens technique) with intravelar veloplasty with regard to postoperative functional outcome of eustachian tube and velopharyngeal competence. METHODS A prospective cohort study was conducted enrolling 70 patients with nonsyndromic cleft palate (except submucous type of cleft) over a period of 2 years. They were divided into two main groups according to the type of cleft palate: group A (Veau class II) included 32 patients and group B (Veau class I) included 38 patients. In each group, Wardill-Kilner palatoplasty (two-layer repair without intravelar veloplasty) versus Kriens palatoplasty (three-layer repair with intravelar veloplasty) was randomly selected for patients. RESULTS For the three-layer palatoplasty in both groups, there was a greater tendency for resolution of secretory otitis media in the early postoperative period, less time required for extrusion of the grommet tube, and a lower incidence of recurrent secretory otitis media. The incidence of postoperative velopharyngeal incompetence was greater with two-layer palatoplasty group. The incidence of palatal fistula was greater with three-layer palatoplasty. CONCLUSIONS Palatal muscle reconstruction in cleft palate patients confers better functional results regarding velopharyngeal competence and eustachian tube function. Although the overall incidence of postoperative palatal fistula is within the accepted range, the incidence of fistula is higher in the palatal muscle reconstruction subgroup. Future studies are required that include a larger number of patients.
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Affiliation(s)
- Mohamed E Hassan
- Zagazig City, Egypt From the General Surgery Department, Pediatric Surgery Unit, and Department of Otolaryngology, Faculty of Medicine, Zagazig University
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David DJ, Anderson PJ, Schnitt DE, Nugent MAC, Sells R. From Birth to Maturity: A Group of Patients Who Have Completed Their Protocol Management. Part II. Isolated Cleft Palate. Plast Reconstr Surg 2006; 117:515-26. [PMID: 16462334 DOI: 10.1097/01.prs.0000197135.95344.a0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal management of the cleft palate patient from birth to completion of treatment continues to present a formidable challenge to the plastic surgeon. The management by multidisciplinary teams is well established, but long-term outcome data of cases managed by protocol remain sparse. This study continues to present the results of the Australian Craniofacial Unit of patients with isolated cleft palate who completed protocol management at the unit under the care of the senior author (D.J.D.) during the 29-year period from 1974 to 2003. METHODS A retrospective study of the outcomes in relation to facial growth, speech, hearing, and occlusion is presented of patients with an isolated cleft palate. RESULTS Thirty-two cases were identified from the departmental database, involving 17 female patients and 15 male patients. Cephalometric analysis at skeletal maturity revealed a range of facial growth, and maxillary advancement surgery was deemed necessary in just two cases. Speech results were evaluated using speech therapy assessments during development and at maturity. At maturity, 18 of 32 patients were assessed as being within normal limits. The hearing was within -20 dB, with just two exceptions. CONCLUSION Overall, these is a range of outcomes, but the results confirm that facial growth does not appear to be adversely affected by use of the pushback technique to reconstruct the palate.
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Affiliation(s)
- David J David
- Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
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Hou Q, Freeman R, Buttery LDK, Shakesheff KM. Novel Surface Entrapment Process for the Incorporation of Bioactive Molecules within Preformed Alginate Fibers. Biomacromolecules 2005; 6:734-40. [PMID: 15762637 DOI: 10.1021/bm049420x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A physical entrapment technique has been developed for the surface engineering of preformed alginate fibers. Surface engineering was carried out at room temperature in aqueous solutions without additional solvent, a catalyst/initiator, a chemical cross-linking agent, or a temperature increase. Entrapment of surface-modifying molecules was achieved by exposing the alginate fibers to a Na(+)-rich NaCl/CaCl2 mixture solution, which caused the formation of a moderate dissociation layer into which the modifier could diffuse within a few seconds. The surface dissociation was then reversed by the addition of a large excess of multivalent cations, which resulted in collapse of the interface and immobilization of the modifying species. Rhodamine-tagged poly(ethylene glycol)s of different molecular weights were used as model molecules to investigate the effect of process parameters on the entrapment efficiency. It was found that the entrapment efficiency as well as the distribution of the modifier within the alginate fibers was determined by several factors, including the NaCl/CaCl2 ratio in the preswelling solution, exposure time, and concentration and molecular weight of the modifiers. The morphology of the fibers was not significantly changed in terms of shape and size after the entrapment process. By this technique, poly(L-lysine) (PLL) coupled with cell adhesion peptide sequence GRGDS (PLL-GRGDS) was entrapped within alginate fibers, and it was demonstrated that the modification promoted the attachment of mouse 3T3 fibroblasts.
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Affiliation(s)
- Qingpu Hou
- School of Pharmacy, The University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
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