Change in Initial Tympanostomy Tube Placement Timing Yields Decreased Burden of Care Without Increased Complications in Patients With Cleft Lip and Palate

Abstract

Objective: To report a practice audit of the consequences of a change in protocol in the timing of placement of tympanostomy tubes in infants with cleft lip and palate. Participants: All children with a diagnosis of cleft lip and palate, treated between November 1998 and May 2006 under the old protocol, and between December 2012 and July 2016 under a new protocol. Under the old protocol, tympanostomy tubes were first inserted at the time of lip repair at around age 2 months. Under the new protocol, tympanostomy tubes were deferred until the time of palate repair around the age of 9 months. Children with syndromic diagnoses other than Stickler syndrome and Van der Woude syndrome, and children who failed newborn hearing screen were excluded. Main Outcome Measures: Incidence of otorrhea from birth to 6 months after palate repair and presence of hearing loss at ages 1 and 2. Results: Deferral of tympanostomy tubes until the time of palate repair decreases the burden of care due to otorrhea as compared to early tympanostomy tubes at the time of lip repair. There was no significant difference in the incidence of hearing thresholds at or below 15 dB at age 1 or 2. Conclusions: Placement of tympanostomy tubes at the time of palate repair balances the goals of minimizing the adverse effects from middle ear effusion and minimizing the burden of care on our patients and their families.

Relationship between cleft palate width and otitis media

“…Several studies on the timing of VTI have reported that VT insertion before the age of 6 months is beneficial 12,14 although VTI before palatoplasty increases the risk of prolonged otorrhea. 15,16 The present study found no significant association between cleft Schwarz et al 13 explained that in patients with a wide cleft, the surgeon must mobilize tissue more extensively and perform the adaption under a higher tissue drag. The drag on the eustachian tube may increase in patients with a wider cleft, enabling better middle ear ventilation.…”

“…The results of our study suggested that earlier VTI may be effective in patients with OME with a wide cleft who are often more prone to exacerbation and have a high incidence of severe AOM. Several studies on the timing of VTI have reported that VT insertion before the age of 6 months is beneficial 12,14 although VTI before palatoplasty increases the risk of prolonged otorrhea 15,16 …”

“…Several studies on the timing of VTI have reported that VT insertion before the age of 6 months is beneficial 12 , 14 although VTI before palatoplasty increases the risk of prolonged otorrhea. 15 , 16 …”

Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care

“…Additionally, uncertainty exists regarding whether VTI for OME benefits hearing or speech outcomes in patients with CLP (Zheng et al, 2003). Recent studies demonstrated a potential benefit in VTI prior to palatoplasty, yet the evidence is not widely accepted (Davis et al, 2020; Koempel et al, 2021). In contrast, recurrent OME or tube extrusion can occur frequently requiring repeat tympanostomies or long-term tube placement.…”