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

Abstract

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.

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

“…[3][4][5] Not surprisingly, complications of chronic Eustachian tube dysfunction-chronic otitis media with effusions, conductive hearing loss, tympanic membrane perforation, and cholesteatoma-are more common in children with cleft palate than those without and can contribute to speech delay in children already at risk for resonance and articulation issues. [6][7][8][9][10] Many questions persist regarding the management of middle ear disease in children with cleft palate. Since the recognition of the high prevalence of middle ear effusions in infancy, many surgeons have adopted a pattern of routine tympanostomy tube insertion to coincide with other planned procedures.…”

“…The association between Eustachian tube dysfunction and palatal clefting is thought to be primarily due to the suboptimal angle, strength, and composition of the tensor veli palatini (and levator palatini to a lesser degree) muscles in children with cleft palate that does not fully resolve with palate repair . Not surprisingly, complications of chronic Eustachian tube dysfunction—chronic otitis media with effusions, conductive hearing loss, tympanic membrane perforation, and cholesteatoma—are more common in children with cleft palate than those without and can contribute to speech delay in children already at risk for resonance and articulation issues …”

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

“…In a retrospective study by Shaffer and colleagues on 318 children with cleft palate, the impact of hearing loss and timing of VT insertion on speech outcomes was analyzed. Hearing loss after multiple tube treatment were associated with speech and language delays, but there was no evidence to support VT before palatoplasty (Shaffer et al, 2017).…”

“…If hearing impairment caused by otitis media is a risk factor for delayed speech and language development and later problem with academic achievement in children with cleft palate, has been discussed but not yet clarified. (Eshghi et al, 2019;Schonweiler et al, 1999;Shaffer et al, 2017). However, extended knowledge on hearing loss related to otitis media with effusion (OME) in children with cleft palate is needed before its relationship with speech and language development can be further explored.…”

Habilidades do desenvolvimento global e comunicativo de crianças com fissura labiopalatina

“…A FLP pode também trazer prejuízos relevantes, como alterações relacionadas à deformidade dentofacial e disfunção velofaríngea (DVF), em sua maioria manifestando alterações na produção articulatória e hipernasalidade de fala (HARDIN-JONES et al, 2002;HARDIN-JONES, 2003;GENARO et al, 2004;PEGORARO-KROOK et al, 2004;HENNINGSSON et al, 2008;DUTKA;PEGORARO-KROOK, 2014 Os indivíduos com FLP apresentam alta ocorrência de distúrbio de audição, devido as alterações anatomofuncionais, comprometendo o funcionamento da orelha média que podem favorecer quadros de otites de repetição (BROEN et al, 1998;DONADON;VIEIRA, 1999;KEMALOGLU;KOBAYASHI;KAKAJIMA, 1999;HANDŽIĆ-ĆUK et al, 2001;SHEAHAN et al, 2003;RAMANA et al, 2005;PEGORARO-KROOK et al, 2004;AMARAL;EDUARDO, 2010;DUTKA;PEGORARO-KROOK, 2014;SUNDMAN et al, 2016 (SHAFFER et al, 2017).…”