Prognostic Factors for Hearing Outcomes in Children with Cleft Lip and Palate

Abstract

Background: This study was performed to investigate the prognostic factors that influence hearing outcomes of children with cleft lip and palate after ventilation tube insertion. Methods: The authors retrospectively reviewed the hearing thresholds of 90 children with cleft lip and palate and performed univariate and multivariate analyses of five prognostic factors for hearing outcomes: age at palatoplasty, age at first ventilation tube insertion, timing of ventilation tube insertion, frequency of ventilation tube insertion, and type of cleft palate. Results: On univariate analysis, the authors found that older age at palatoplasty (p = 0.002), older age at first ventilation tube insertion (p = 0.025), and increased frequency of ventilation tube insertion (p = 0.048) were significant prognostic factors for poorer hearing outcomes in children with cleft lip and palate. Multiple logistic regression analysis showed that late palatoplasty (age older than 1 year) was the most influential factor for poor hearing outcome (OR, 2.83), followed by two or more ventilation tube insertions (OR, 1.94). Conclusion: The age at palatoplasty and frequency of ventilation tube insertion were found to be significant prognostic factors influencing hearing outcomes in children with cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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

“…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). Conversely, Hubbard et al (1985) reported superior hearing outcomes in a cohort of patients with tympanostomy tubes inserted at an average age of 3 months compared to 30 months.…”

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

“…13 In current literature, different approaches are presented for the treatment of patients with cleft palate and with conductive hearing loss due to effusion in the tympanic cavity. [14][15][16][17] Paracentesis and tympanostomy tube surgery (TTS) are the main treatment options for correcting middle ear dysfunction. This study evaluates the prevalence of tympanostomy tube placement in patients with cleft deformities in relation to the absolute and relative cleft width and cleft classification.…”

The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

“…As with the literature regarding maxillofacial growth, several considerations complicate the interpretation of the literature examining the impact of timing of palatoplasty on speech and language outcomes. First, variability in criteria used to define “early” and “late” palatoplasty exists, with early age for simultaneous soft and hard palate repair ranging from 3 months (Kaplan, 1981) to 6 months (Ysunza et al, 1998; Kirschner et al, 2000) to 24 months (Yang et al, 2013), and late age ranging from >12 months (Randall et al, 1986; Yang et al, 2019) to >18 months (Pasick et al, 2014) to >2 years (Zhao et al, 2012; Guneren et al, 2015; Carlson et al, 2016; Menegueti et al, 2017), depending on the study. Further variability is introduced by studies examining staged closure of the soft and hard palate (Cosman and Falk, 1980; Randall et al, 1983; Kirschner et al, 2000; Holland et al, 2007; Yamanishi et al, 2011).…”