Evaluation of Ventilation Tube Placement and Long-term Audiologic Outcome in Children with Cleft Palate

Kim, Elissa; Kanack, Melissa; Dang-Vu, Milan D.; Carvalho, Daniela; Jones, Marilyn C.; Gosman, Amanda

doi:10.1597/15-349

Cited by 21 publications

(24 citation statements)

References 29 publications

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“…Prior studies differed on the association of ear and hearing outcomes with cleft palate type. 19,25,26,33 Our results suggest a role for controlling for genetic syndromes and anomalies when analyzing the association between hearing loss and cleft severity.…”

Section: Discussionmentioning

confidence: 73%

“…Concerns have since been raised regarding complications and poorer hearing outcomes associated with the increased numbers of tubes and use of long-acting tubes among children with cleft palate. 6,[17][18][19][20] A more conservative approach to middle ear disease management includes selective placement in accordance to clinical practice guidelines for children without clefting (eg, chronic effusion .3 months associated with hearing loss). 21 Multiple systematic reviews were recently published to explore the outcomes associated with early routine tympanostomy tube placement in children with cleft palate, identifying a need for further research in this area.…”

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confidence: 99%

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

Funamura

Lee

McKinney

et al. 2019

Otolaryngol.--head neck surg.

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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.

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Section: Discussionmentioning

confidence: 73%

mentioning

confidence: 99%

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

Funamura

Lee

McKinney

et al. 2019

Otolaryngol.--head neck surg.

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“…Receiving a greater number of tubes was associated with HL after tubes, language delays, and SSPDs. Previously, Goudy et al 49 and Kim et al 50 also found that patients with HL received a greater number of tubes. This is expected, because recurrent type B tympanograms and PTA >25 dB are indications for tube replacement.…”

Section: Discussionmentioning

confidence: 93%

The Impact of Tympanostomy Tubes on Speech and Language Development in Children with Cleft Palate

Shaffer

Ford

Choi

et al. 2017

Otolaryngol.--head neck surg.

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Objective Describe the impact of hearing loss, tympanostomy tube placement before palatoplasty, and number of tubes received on speech outcomes in children with cleft palate. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods Records from 737 children born between April 2005 and April 2015 who underwent palatoplasty at a tertiary children's hospital were reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, sensorineural or mixed hearing loss, no tubes, first tubes after palatoplasty, or first clinic after 12 months of age. Data from 152 patients with isolated cleft palate and 166 patients with cleft lip and palate were analyzed using Wilcoxon rank-sum, χ, and Fisher exact test and logistic regression. Results Most patients (242, 76.1%) received tubes before palatoplasty. Hearing loss after tubes, but not before, was associated with speech/language delays at 24 months ( P = .005) and language delays ( P = .048) and speech sound production disorders (SSPDs, P = .040) at 5 years. Receiving tubes before palatoplasty was associated with failed newborn hearing screen ( P = .001) and younger age at first posttubes type B tympanogram with normal canal volume ( P = .015). Hearing loss after tubes ( P = .021), language delays ( P = .025), SSPDs ( P = .003), and velopharyngeal insufficiency ( P = .032) at 5 years and speech surgery ( P = .022) were associated with more tubes. Conclusion Continued middle ear disease, reflected by hearing loss and multiple tubes, may impair speech and language development. Inserting tubes before palatoplasty did not mitigate these impairments better than later tube placement.

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“…A review of the literature reveals multiple conflicting studies. Kim et al (2017) investigated hearing outcomes between children with their first tympanostomy tubes placed before and after 8 years of age and found no statistically significant difference in outcomes. Another study compared intervention before and after 1 year of age and did find better hearing outcomes with earlier intervention, but this association disappeared upon multivariate analysis (Yang et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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

Davis

Cohen

Matthews

2020

The Cleft Palate-Craniofacial Journal

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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.

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Evaluation of Ventilation Tube Placement and Long-term Audiologic Outcome in Children with Cleft Palate

Cited by 21 publications

References 29 publications

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

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

The Impact of Tympanostomy Tubes on Speech and Language Development in Children with Cleft Palate

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

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