Cartilage Tympanoplasty in Children With Cleft Palate Repair

Metrailer, Aaron M.; Cox, Matthew D.; Sunde, Jumin; Hartzell, Larry; Moore, Page C.; Dornhoffer, John L.

doi:10.1097/mao.0000000000000473

Cited by 4 publications

(6 citation statements)

References 10 publications

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“…Other authors advocate an aggressive approach with cartilage grafting using the same algorithm as for children without orofacial clefting. 39,41…”

Section: Discussionmentioning

confidence: 99%

“…Other authors advocate an aggressive approach with cartilage grafting using the same algorithm as for children without orofacial clefting. 39,41 As with any retrospective study, there are inherent limitations. Various practitioners examined the patients and performed audiometric testing, and different equipment was used.…”

Section: Discussionmentioning

confidence: 99%

“…Several factors played a role in whether to recommend tympanoplasty, including the presence or absence of otorrhea, conductive hearing loss, and the appearance of the contralateral ear. Other authors advocate an aggressive approach with cartilage grafting using the same algorithm as for children without orofacial clefting 39,41 …”

Section: Discussionmentioning

confidence: 99%

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

Imbery

Sobin

Commesso

et al. 2017

Otolaryngol.--head neck surg.

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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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“…Other authors advocate an aggressive approach with cartilage grafting using the same algorithm as for children without orofacial clefting. 39,41…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Imbery

Sobin

Commesso

et al. 2017

Otolaryngol.--head neck surg.

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“…Notably, Metrailer et al and Gardner and Dornhoffer regarded postoperative tympanostomy tubes a success, whereas Juergens et al defined this outcome as a failure of the tympanoplasty. 29,45,52 These differences question graft success comparisons between studies and how the results would have changed if a uniform definition had been adopted. Follow-up was also variable among the studies, ranging from 25.0 to 160.8 months.…”

Section: Discussionmentioning

confidence: 99%

“…Eight studies had extractable outcome data on graft success for patients with a cleft palate repair, 28,29,[43][44][45][46]50,52 and 5 studies had similar data for controls. 28,29,43,46,50 Graft success was defined by each study's criteria at its particular follow-up timepoint.…”

Section: Graft Successmentioning

confidence: 99%

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

Poupore

Smaily

Carroll

et al. 2022

Otolaryngol.--head neck surg.

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Objective To analyze graft success rates and hearing outcomes in patients with a history of cleft palate (CP) repair undergoing tympanoplasty. Data Sources PubMed, Scopus, and CINAHL. Review Methods Per PRISMA guidelines, the databases were searched from date of inception through December 14, 2021. Studies of patients with previous CP repair who underwent tympanoplasty were included. Meta-analysis of proportions, continuous measures, odds ratios (ORs), and meta-regression were used to analyze graft success and hearing outcomes after tympanoplasty. Results A total of 323 patients with CP repair and 1169 controls were included. The proportion of graft success was 86.7% (95% CI, 76.1%-94.5%) in patients with CP repair and 88.8% (95% CI, 76.9-96.8) in controls. There was no difference in odds of graft success between patients with CP repair and controls (OR, 1.0 [95% CI, 0.5-1.8]; P = .870). Age was not a significant moderator of graft success in patients with CP repair ( r = 0.1 [95% CI, −0.2 to 0.3]; P = .689) or controls ( r = −0.0 [95% CI, −0.1 to 0.1]; P = .952). Comparing mean differences between pre- and postoperative air-bone gap was not statistically significant in patients with CP repair and controls (0.2 dB [95% CI, −3.1 to 3.4]; P = .930). Odds of functional success (postoperative air-bone gap <20 dB) were not different between the groups (OR, 0.8 [95% CI, 0.5-1.4]; P = .450). Conclusion This meta-analysis does not endorse anatomic or functional differences between patients with CP repair and controls after tympanoplasty. However, there is a paucity of evidence for younger children. Further studies are warranted to elucidate specific risk factors for tympanoplasty outcomes in young patients with previous CP repair.

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