Audiologic and Tympanometric Findings in Children with Cleft Lip and Palate

Abstract

Objective To evaluate the otologic and audiologic status of 50 children with repaired cleft lip, cleft palate, or both in Hacettepe University, Ankara, Turkey. Design Audiometric and tympanometric evaluation of 100 ears in 50 children were performed. Hearing levels ≤ 15 dB and middle ear pressures between −50 to +50 decaPascals were considered to be normal. Results were examined according to cleft type and laterality. The least and most affected frequencies were calculated. A simple evaluation of speech characteristics including nasal resonance, nasal air escape, and errors of articulation was also performed. Results Sixty-three of the 100 ears had normal hearing status, whereas 40 had normal middle ear pressures. No evidence was found to suggest that individual cleft type and laterality of the ear had any effect on hearing loss or middle ear disease. Two-thirds of the patients had normal or acceptable degree of language skills. Conclusion The final hearing status of patients with cleft palate is a result of a combination of surgical correction, developmental factors, and treatment of middle ear disease. Early and aggressive ventilation tube placement is the standard of cleft care in many countries. Our long-term hearing outcome is relatively good in a population not treated with routine insertion of ventilation tubes. The majority of patients also have satisfactory speech. Patients with cleft palate should have close follow-up for middle ear disease, but further research is warranted to determine the aggressive usage of ventilation tubes.

Profile of patients with cleft palate fitted with hearing AIDS

“…Our findings depict structural and functional changes introduced by the occurrence of cleft palate, such as Eustachian tube disorders and middle ear infections, apart from increased rates of respiratory tract infections, hypertrophic tonsil and adenoids, and immune disorders connected to lack of breastfeeding during infancy. 2 , 3 , 4 , 5 , 6 , 9 , 10 , 15 , 32 , 33 …”

“…The significant degree of association between cleft lip and palate and changes in the middle ear has been profusely described in the literature 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 with wide agreement among authors. The most adequate therapy mode for this disorder remains yet controversial.…”

“…Various studies have supported the importance of using antibiotics and inserting the Eustachian tube during palate repair surgery to prevent the occurrence of middle ear disorders and their consequences. 10 , 13 , 14 , 15 , 16 , 17 Other studies 2 , 7 , 8 ,9, 18 , 19 reported high rates of long term side effects such as perforation and retraction of the tympanic membrane, chronic otitis media, and hearing loss in the ears treated with tube ventilation insertion. Ideal treatment was then defined as otorhinolaryngological and audiological follow-up, accompanied by aural rehabilitation and use of hearing aids.…”

“…Cleft lip and palate patients present middle ear ventilation problems resulting from changes in the movement of the Eustachian tube caused by inadequate insertion of the palate tensor and elevator muscles, thus producing a functional obstruction on the Eustachian tube and negative pressure in the middle ear, leading to otitis media. 2 3 …”

Cleft palate children: performance in auditory processing tests

“…9 , 10 the main reason for this seems to be a failure in the Eustachian Tube opening, consequent to an abnormal insertion of the soft palate elevator and tensor muscles, causing Eustachian Tube obstruction and negative pressure in the middle ear 11 ; Eustachian tube incapacity in balancing positive and negative pressures, because of its reduced elasticity and consequent functional obstruction 12 ; abnormality in tube compliance13; tube patency–the property of the tube in opening up more than what is normal, allowing secretions to pass from the nasopharynx to the tympanic cavity 14 ; and facial skeleton abnormalities 15 have been suggested as contributing factors. Thus, a high occurrence of OME and hearing loss have been found in these children with labio-palatine fissure, even after palate repair, because despite soft palate tensor muscle improvement after this surgical procedure, it is hardly normalized, and the patient may still have constant otitis episodes 16 , 17 , 18 , 19 , 20 .…”