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

Abstract

Objectives To characterize the duration of Eustachian tube dysfunction in children with cleft palate compared to those without cleft palate by performing time‐to‐event analysis on tympanometric data. To determine predictive characteristics of earlier achievement of normal tympanograms in children with cleft palate. Methods Longitudinal tympanometric data from a minimum of 10 years at a single center were reviewed for children with cleft palate born in the years 2003 through 2007. Children with cleft lip without cleft palate born in the same years were used as a reference group to compare children with similar length of follow‐up. The association between time to sustained normal (type A) tympanograms with patient demographics, clinical characteristics, and otologic history was evaluated using time‐to‐event analysis and compared with log rank tests. Adjusted and unadjusted hazard ratios were estimated using Cox proportional hazard models. Results The median age of achieving a type A tympanogram in children with cleft palate was 9.9 years for one and 12.1 years for both ears, compared to 7.1 and 7.4 years in children with cleft lip only (P < 0.0001). On multivariate analysis, clinical characteristics such as the severity of palatal clefting or the presence of a cleft‐associated syndrome/sequence were not predictors of a longer time to a type A tympanogram. Conclusion Our results help characterize the observation that there is delayed time to normal Eustachian tube function in children with cleft palate, which is not associated with the degree of palatal clefting. Level of Evidence 3b Laryngoscope, 130:1044–1050, 2020

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). This is consistent with our anecdotal institutional experience.…”

Prevalence of Tympanostomy Tube Placement in Relation to Cleft Width and Type

“…With cleft palates, muscles of the soft palate are not united at the median raphe and middle ear ventilation is not guaranteed. 4 Inflammatory and non-inflammatory effusion can therefore develop in the tympanic cavity and lead to hearing impairment. 5,19 In this study, 78 patients with cleft palate were included.…”

“…2 Due to the incomplete fusion of these muscles in the median raphe, 3 the Eustachian tube does not open correctly in patients with cleft palate. 4 Subsequently, inflammatory and non-inflammatory effusion of the tympanic cavity can occur. 5 In fact, more than 80% of patients with cleft deformity show pathologies of the middle ear in the first 2 years of their lives.…”

The Effect of Intervelar Veloplasty Under Magnification (Sommerlad’s Technique) Without Tympanostomy on Middle Ear Effusion in Cleft Palate Patients

“…The orofacial cleft with the prevalence of one in 700 births is considered the most common birth anomaly [1]. Likewise, persistent eustachian tube dysfunction is thought to be the primary factor responsible for the higher rates of more serious middle ear pathology observed in children with cleft palate, such as tympanic membrane perforation, middle ear atelectasis, cholesteatoma, and otitis media with effusion (OME) [2]. Moreover, OME entangles approximately 30 to 40 % of children at least once while rising to more than 90 % in children with CP [3,4].…”