Grommets for Otitis Media With Effusion in Children With Cleft Palate: A Systematic Review

Abstract

BACKGROUND AND OBJECTIVE: No consensus has yet been reached with regard to the link between otitis media with effusion (OME), hearing loss, and language development in children with cleft palate. The objective of this study was to address the effectiveness of ventilation tube insertion (VTI) for OME in children with cleft palate. METHODS:A dual review process was used to assess eligible studies drawn from PubMed, Medline via Ovid, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and reference lists between 1948 and November 2013. Potentially relevant papers were selected according to the full text of the articles. Relevant data were extracted onto a data extraction sheet. RESULTS:Nine high-or moderate-quality cohort studies were included in this study. VTI was administered in 38% to 53% of the OME cases, and more severe cases appeared more likely to undergo VTI. Compared with conservative forms of management (eg, watchful waiting), VTI has been shown to be beneficial to the recovery of hearing in children with cleft palate and OME. A growing body of evidence demonstrates the benefits of VTI in the development of speech and language in children with cleft palate and OME. These children face a higher risk of complications than those undergoing conservative treatments, the most common of which are eardrum retraction and tympanosclerosis, with an incidence of ∼11% to 37%. CONCLUSIONS:This review provides evidence-based information related to the selection of treatment for OME in children with cleft palate. Additional randomized controlled trials are required to obtain bias-resistant evidence capable of reliably guiding treatment decisions. The conclusions in this review are based on underpowered cohort studies and very-low-strength evidence. Dr Kuo contributed to the conception and design of this research and the acquisition, analysis, and interpretation of data, drafted the first version of the manuscript, and participated in a critical revision of the manuscript; Dr Tsao contributed to the conception and design of the research and the acquisition, analysis, and interpretation of data and participated in revising the manuscript; Dr Cheng participated in the conception and design of the research and the analysis and interpretation of data and approved revisions to the manuscript; Drs Lien, Hsu, and Huang participated in the conception and design of the research, analysis and interpretation of data, and revision of the manuscript; Dr Shiao contributed to the conception and design of the research, acquisition, analysis, and interpretation of data and participated in critical revisions of the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

The Primary Care Pediatrician and the Care of Children With Cleft Lip and/or Cleft Palate

“…A 2014 systematic review identified that children with CP ± CL and otitis media with effusion who receive tympanostomy tubes have better long-term speech and language outcomes. 32 Children with CP need regular audiologic evaluation and otolaryngology assessment as part of cleft/craniofacial team care.…”

Tympanostomy Tube Placement for Otitis Media with Effusion in Children with Cleft Lip and Palate

“…A recent systematic review by Kuo et al published in Pediatrics addressed the effects of VTI in children with cleft palate and OME with regard to patient-centered outcomes [109]. The review followed the protocol outlined in Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) to enable full and transparent assessment of the existing literature, in order to provide evidence-based information pertaining to the management of OME in children with cleft palate.…”

Strategies for the Management of Post-Irradiation Otitis Media with Effusion

“…Non-radiation induced OME (e.g. OME induced by an infection in the upper respiratory tract) is commonly caused by temporary dysfunction of the Eustachian tube with regard to ventilation, and can usually be "cured" using conventional treatments [12,13]. In contrast, the generally acknowledged etiologies of post-irradiation OME are associated with direct and irreversible radiation-induced damage to the Eustachian tube, including scarring of the tubal opening, poor mucociliary function, and fibrosis of tube-associated muscles.…”