A conservative approach to the management of otitis media with effusion in cleft palate children

Abstract

Otitis media with effusion (OME) is almost universal in children born with a cleft palate. Early placement of a ventilation tube to alleviate hearing problems is common. A retrospective study has been carried out to assess whether the practice of tube placement only for definite clinical indications is successful in terms of subsequent hearing levels and speech and language development. This was assessed by a case note review, analysis of speech therapy data and by means of a special follow-up clinic.There was no difference in speech development between those treated with tube insertion for OME and those untreated. Audiological thresholds were worse in the treated group. A similar number in each group required regular speech therapy. More abnormal otological findings were present at follow up in those who had tubes inserted, some of these were directly attributable to the presence of tubes.A conservative management of OME in cleft palate children, with tube insertion for only definite clinical indications, is an appropriate management, and will lead to fewer otological complications of tube insertion.

The prevalence of otological manifestations in children with cleft palate

“…There was no history of hearing problems obtained from the parents of the participants. Previous studies have documented the absence of clinically signifi cant hearing loss in children with cleft [13][14][15]. Some investigators have, however, commented on varying degrees of hearing loss found in children with cleft palate [4,12,16].…”

Tympanostomy Tube Placement for Otitis Media with Effusion in Children with Cleft Lip and Palate

“…A number of researchers have reported that OME and Eustachian tube function improve as the patient grows older [41,43,44], recommending watchful waiting for CLP children with OME for a period of 3-6 months from the diagnosis of effusion [41,[43][44][45]. During the observation period, patients can wear hearing aids to attain the same hearing performance of children with ventilation tubes [45]; however, it should be noted that children may find hearing aids inconvenient or may worry about the social stigma associated with wearing such aids [27,46].…”

“…Several prospective [51,59,60] and retrospective [20,44,46,52,[61][62][63][64][65][66][67][68] cohort studies evaluated hearing outcomes. Among these cohort studies, several studies compared VTI with non-VTI (i.e., myringotomy alone, hearing aids, watchful waiting) [44,60,62,[64][65][66][67][68].…”

“…Among these cohort studies, several studies compared VTI with non-VTI (i.e., myringotomy alone, hearing aids, watchful waiting) [44,60,62,[64][65][66][67][68]. It has been reported that the improvements in hearing afforded by VTI over the short term (within 18 months after VTI) are more pronounced than those of myringotomy, watchful waiting, or HA [64][65][66].…”

“…Some cohort studies observed that CLP children that had undergone VTI for OME presented worse hearing outcomes over the short term (less than 5 years) [44] or a higher percentage of ears with hearing loss after surgery over the long term (9-21 years), compared to children that did not undergo the procedure [62,67].…”