Long‐Term Otologic and Audiometric Outcomes in Patients with Cleft Palate

Abstract

Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center. Methods Charts of 564 patients with a diagnosis of cleft palate (59% syndromic etiology, 41% nonsyndromic) from 1998 to 2014 were reviewed. Patients without at least 1 audiometric follow-up were excluded from analysis. Patient demographics, surgeries, audiometric tests, and otologic data were recorded for 352 patients. Results Forty-five percent had isolated cleft palates, 34% had unilateral cleft lip and palate, and 21% had bilateral cleft lip and palate. Patients were followed for a mean of 50.3 months with a mean of 3.2 separate audiograms performed. Patients received a mean of 2.93 pressure equalization tubes. Increased number of pressure equalization tubes was not associated with incidence of cholesteatoma, which was identified in only 4 patients. Nine patients underwent eventual tympanoplasty with an 89% closure rate. Analysis of mean air-bone gap by cleft type did not reveal significant differences ( P = .08), but conductive losses and abnormal tympanometry persisted into teenage years. Conclusions Patients with cleft palates have eustachian tube dysfunction, which, in our cohort, resulted in persistent conductive hearing loss, highlighting the importance of long-term follow-up. Cholesteatoma incidence was low and not associated with number of tubes, which at our institution were placed prophylactically. Tympanoplasty was successful in those with persistent perforations.

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

“…Chronic Eustachian tube dysfunction today is a well‐recognized phenomenon in children with cleft palate for which the natural history is further characterized by the results of this study. Previous work has described effective use of proactive treatment of otitis media with effusion by routine placement of tympanostomy tubes in this patient population, but the length of time for which we should be proactive is not precisely known . It has been shown that middle ear disease, while widely prevalent in children with cleft palate ages 4 through 6 years, generally presents with a lower burden of disease by age 12 years .…”

“…Previous work has described effective use of proactive treatment of otitis media with effusion by routine placement of tympanostomy tubes in this patient population, but the length of time for which we should be proactive is not precisely known. [17][18][19][20] It has been shown that middle ear disease, while widely prevalent in children with cleft palate ages 4 through 6 years, generally presents with a lower burden of disease by age 12 years. 7 In a prior crosssectional analysis of children with cleft palate, Handzic-Cuk et al also demonstrated that the median age for type A tympanograms at their institution was 11 years.…”

Clinical Study on Middle Ear Diseases in Children with Orofacial Clefts

“…Imbery et al revealed the importance of routine follow-up care by an otolaryngologist to minimize the complications of ear disease. The rate of cholesteatoma formation was reduced from 9% to 3% when a coordinated team approach was instituted to care for the orofacial cleft patients [ 17 ]. Once again stressing on the significance of routine ear check-ups, Goudy S et al claimed that 50% of orofacial cleft children continue to suffer from ear diseases as adults, making it a difficult situation to manage [ 18 ].…”

Hearing Thresholds in Young Children With Otitis Media With Effusion With and Without Cleft Palate

“…Treatment with ventilation tubes (VT) are very common in children with CP±L, often at the time of the palatal repair. The optimal time for VT insertion and the risk for complications as otorrhea, myringosclerosis, retraction, perforation and granulation of the tympanic membrane, permanent hearing impairment, and post-VT insertion cholesteatoma has been discussed in many studies (Imbery et al, 2017;Karanth and Whittemore, 2018;Klockars and Rautio, 2012;Phua et al, 2009;Ponduri et al, 2009;Shaffer et al, 2018). In a systematic review by Kuo and colleagues, post-VT complications and sequelae are described in seven articles.…”