Children with Cleft Palate: Predictors of Otologic Issues in the First 10 Years

Abstract

Objective To evaluate the characteristics of children with cleft palate associated with persistent otologic issues in the first 10 years of life. Study Design Case series with chart review. Setting Single academic center. Subjects and Methods Children born with cleft palate from 2003 to 2007 and treated by the UC Davis Cleft and Craniofacial Team between January 2003 and December 2017 were included in the study. Data from 143 patients were analyzed via Wilcoxon rank sum and Fisher exact tests for univariate analysis and logistic regression to determine adjusted odds ratios. Results The median length of follow-up was 9.9 years, and the age at last ear examination was 10.7 years. At the last evaluation, unresolved otologic issues were common, with at least 1 ear having a tympanic membrane (TM) perforation (16.1%), a tympanostomy tube (36.2%), or conductive hearing loss (23.1%). After adjusting for demographic and clinical characteristics, history of palate revision or speech surgery was associated with having a TM perforation (P = .02). The only clinical variables associated with conductive hearing loss was the presence of a TM perforation (P < .01) or a genetic abnormality (P = .02). Severity of palatal clefting was not associated with specific otologic or audiologic outcomes after adjusting for other characteristics. Conclusion A large proportion of children with cleft palate have persistent otologic issues at age 10 years and would benefit from continued close monitoring well after the age when most children have normalized eustachian tube function. Prolonged otologic issues were not found to be associated with cleft type.

Eustachian tube dysfunction in children with cleft palate: A tympanometric time‐to‐event analysis

“…Although the exact age is not known, children with cleft palate are thought to have a median age of normalized Eustachian tube function well past the population average of 7 years . With regard to predictive clinical characteristics, previous work from our group would also suggest that need for revision cleft palate repair or speech surgery may be associated with longer time to normal Eustachian tube function, but that severity of palatal clefting is not a factor …”

“…3 With regard to predictive clinical characteristics, previous work from our group would also suggest that need for revision cleft palate repair or speech surgery may be associated with longer time to normal Eustachian tube function, but that severity of palatal clefting is not a factor. 16 The purpose of this study is to expand on our prior investigation of otologic outcomes in children with cleft palate by characterizing the duration of Eustachian tube dysfunction with a longitudinal analysis of tympanometric data. Rather than focusing on otologic outcomes (e.g., tympanic membrane perforation) at 10 years of age as in our previous study, 16 all tympanometric results for children with cleft palate (and those with cleft lip but not cleft palate as a reference group) born in the years 2003 through 2007 and followed at our center were evaluated.…”

“…The purpose of this study is to expand on our prior investigation of otologic outcomes in children with cleft palate by characterizing the duration of Eustachian tube dysfunction with a longitudinal analysis of tympanometric data. Rather than focusing on otologic outcomes (e.g., tympanic membrane perforation) at 10 years of age as in our previous study, all tympanometric results for children with cleft palate (and those with cleft lip but not cleft palate as a reference group) born in the years 2003 through 2007 and followed at our center were evaluated. The 10‐plus years of data for this cohort was then examined for each individual to determine the age at which Eustachian tube function normalized.…”

Impact of Surgery for Velopharyngeal Insufficiency on Eustachian Tube Function in Children: Pharyngeal Flap Versus Sphincter Pharyngoplasty

“…Patients with CP (Funamura et al, 2019a) and SMCP (Kwinter et al, 2018) are at higher risk for Eustachian tube dysfunction (ETD) than the general population. A recent study indicated that, among patients with CP, history of revision palatoplasty or speech surgery was a risk factor for ETD (Funamura et al, 2019b).…”

Eustachian Tube Dysfunction in Children With Unilateral Cleft Lip and Palate: Differences Between Ipsilateral and Contralateral Ears

“…Chronic otitis media with effusion, conductive hearing loss, TM perforation, cholesteatoma, and TM retraction are all common in children with CLP (Funamura et al, 2019). These children often require multiple surgical procedures in their first few years of life.…”