Otorrhea in Infants With Tympanostomy Tubes Before and After Surgical Repair of a Cleft Palate

Curtin, Ginny; Messner, Anna H.; Chang, Kay W.

doi:10.1001/archoto.2009.106

Cited by 25 publications

(25 citation statements)

References 11 publications

(12 reference statements)

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“…Otorrhea is known as a complication of inserting tympanostomy tubes in children who are otherwise healthy 40 ; however, post-VTI otorrhea in children with cleft palate has not been comprehensively examined in moderate-or high-quality cohort studies. A number of low-quality cohort and case series studies (not included in our integrated results) reported inconsistent findings about the probability of post-VTI otorrhea occurring in children with cleft palate, ranging from low estimates (4%-11.5%) 41,42 to high (55%-68%).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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

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Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…Ponduri et al A further eight studies of children with CP have been included. 5,[79][80][81][82][83][84][85] In addition, the search was expanded to studies of children without CP or where the presence or absence of a cleft was not specified, this yielded a further 24 studies. [86][87][88][89][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109] Studies did not always clearly state the primary outcome and when this was the case the primary outcome was inferred from the sample size calculation, the study title and/or the results presented first in the results section.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Bruce

Harman

Williamson

et al. 2015

Health Technol Assess

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BackgroundCleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate.ObjectivesTo identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies.DesignThe management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP.SettingThe survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients’ homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting.ParticipantsClinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association.ResultsThe clinician survey revealed that care was predominantly delivered via a ‘hub-and-spoke’ model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research.ConclusionsThere exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered.FundingThe National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.

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“…However, otorrhea has not been systematically studied in CLP children after VTI. Some studies have reported a low probability (4-11.5%) of post-VTI otorrhea in CLP children [44,50,66,79], whereas others reported inconsistent results (55-68%) [31,57,78]. The evidence is inconclusive due to conflicting results among these studies.…”

Section: Otorrheamentioning

confidence: 99%

“…Otorrhea is a complication of the tympanostomy tubes in children who are otherwise healthy [79]. However, otorrhea has not been systematically studied in CLP children after VTI.…”

Section: Otorrheamentioning

confidence: 99%

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

Kuo¹,

Shiao²

2017

Designing Strategies for Cleft Lip and Palate Care

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The condition of cleft lip/palate (CLP) in children is psychologically stressful for family members and debilitating for the patients themselves. These children must undergo a series of major invasive surgeries following birth, including cleft lip repair surgery, cleft palate repair surgery, bone grafting surgery, and dental implant surgery. Unfortunately, the clinical significance of otitis media with effusion (OME), a complication associated with CLP, is often overlooked, and very few studies have explored this condition in depth. This chapter reviews pathogenesis, clinical manifestations, consequences, examination, and diagnosis related to OME in children with CLP. Controversies surrounding the treatment of OME in CLP children are also discussed. We also provide a flowchart for management guidance in OME in children with CLP.

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Otorrhea in Infants With Tympanostomy Tubes Before and After Surgical Repair of a Cleft Palate

Abstract: The incidence of otorrhea after tympanostomy tube placement before CP repair is higher than the incidence after CP repair, although more than half of all infants (19 [58%]) had either 1 or no episodes of otorrhea before CP repair.

Cited by 25 publications

References 11 publications

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

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

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

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

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