Effects of Velopharyngeal Dysfunction on Middle Ear of Repaired Cleft Palate Patients

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

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

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

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

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

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

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

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

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

Surveillance of Otitis Media With Effusion in Thai Children With Cleft Palate

Objective:

To study the incidence and outcome of management of otitis media with effusion in Thai children with cleft palate.

Design:

Retrospective cohort study in the tertiary care center.

Patients:

Ninety-five children with cleft palate were referred for ear evaluation, from June 1997 to January 2015. Fifteen children (15.8%) had associated craniofacial syndromic anomalies.

Main outcome measures:

Cumulative incidence of otitis media with effusion, rate of ventilation tube insertion, duration of indwelling tubes, hearing outcome, and complications of ventilation tubes.

Results:

Ear examinations were done every 8 to 12 weeks throughout the study. Cumulative incidence of otitis media with effusion was 53.7% in children within 12 months of age and 81.1% within 24 months of age. At the end of the study, all of the patients had at least 1 episode of otitis media with effusion. Eighty-eight children (92.6%) had palatoplasty, and there was no significant difference in the incidence of otitis media before and after palatoplasty. The mean hearing level at recruitment was 40.8 ±18.4 dB. Ventilation tube insertion was done in 76 patients (80%). The median time for indwelling tubes was 11.7 months. Rate of ventilation tube insertion was 0.5/year. The mean hearing level at last follow-up was 23.5 ± 14 dB. Otorrhea through tube was found in 24 cases (31.6%).

Conclusion:

Otitis media with effusion was common in Thai children with cleft palate. Surveillance of middle ear effusion and ventilation tube insertion contributed to a favorable hearing outcome.

The tensor stitch for soft palate closure revisited

The tensor veli palatini muscle is involved in opening of the Eustachian tube during chewing and swallowing, allowing for equilibration of pressure between the middle ear and external environment. In patients with cleft palate, abnormal musculature in the region of the cleft results in Eustachian tube dysfunction. A palatoplasty with muscle repositioning is advocated to reduce the incidence of otitis media, which is a result of this. A special suture is described which can be incorporated into a palatoplasty procedure to further reduce the incidence of otitis media. This suture is inserted around the tendon of the tensor veli palatini muscle bilaterally, and when activated under tension in the midline, it results in opening of the Eustachian tube with improved middle ear ventilation. This novel suture results in a reduction in the incidence of otitis media due to improved middle ear ventilation and reduces tension across the suture margins.

Ear Infection in Isolated Cleft Lip: Etiological Implications

BACKGROUND AND HYPOTHESIS

Chronic ear infections are a common occurrence in children with orofacial clefts involving the secondary palate. Less is known about the middle ear status of individuals with isolated clefts of the lip, although several studies have reported elevated rates of ear infection in this group. The purpose of this retrospective study was to test the hypothesis that chronic ear infections occur more frequently in isolated cleft lip cases (n = 94) compared with controls (n = 183).

METHODS

A questionnaire was used to obtain information on history of chronic ear infection. The association between ear infection status (present/absent) and cleft lip status (cleft lip case/control) was tested using both chi-square and logistic regression.

RESULTS AND CONCLUSIONS

The reported occurrence of chronic ear infection was significantly greater in cleft lip cases (31%) compared with unaffected controls (11%). After adjusting for age and sex, having a cleft lip increased the odds of being positive for ear infection by a factor greater than 3 (odds ratio = 3.698; 95% confidence interval = 1.91 to 7.14). Within cleft lip cases, there was no difference in the occurrence of ear infection by defect laterality or by the type of clefting present in the family history. Although velopharyngeal insufficiency was present in 18.4% of our cleft lip sample, there was no statistical association between ear infection and abnormal speech patterns. These results may have potential implications both for the clinical management of isolated cleft lip cases and for understanding the etiology of orofacial clefting.

The Role of Screening Audiometry in the Management of Otitis Media with Effusion in Children with Cleft Palate in Northern Ireland

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.