Treatment of persistent middle ear effusion in cleft palate patients

Szabo, Christian; Langevin, Kerri M.; Schoem, Scott R.; Mabry, Kelly

doi:10.1016/j.ijporl.2010.04.016

Cited by 59 publications

(73 citation statements)

References 11 publications

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“…According to past reports [4][5][6][7] OME is almost universal in CP patients. We found that 70.9% of CP patients developed OME by the age of 1 year.…”

Section: Otitis Media Incidencementioning

confidence: 98%

“…Szabo et al [5] have described that VT placement should be performed in cases where effusion is detected during the operation for CL, and subsequently, bilateral VT placement can be performed if effusion is noted in both ears for 3 months or longer, or if there is a bilateral hearing loss of 325 dB. According to previous reports [6,[8][9][10] VT placement for CP patients should be performed in early infancy.…”

Section: Vt Placementmentioning

confidence: 99%

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Clinical outcomes of ventilation tube placement in children with cleft palate

Kobayashi

Sakuma

Yamada

et al. 2012

International Journal of Pediatric Otorhinolaryngology

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“…According to past reports [4][5][6][7] OME is almost universal in CP patients. We found that 70.9% of CP patients developed OME by the age of 1 year.…”

Section: Otitis Media Incidencementioning

confidence: 98%

Section: Vt Placementmentioning

confidence: 99%

Clinical outcomes of ventilation tube placement in children with cleft palate

Kobayashi

Sakuma

Yamada

et al. 2012

International Journal of Pediatric Otorhinolaryngology

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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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“…A significant proportion (53.2-98%) of CLP children with OME required VTI [4,51,54,61,78] with an average of between 0.55 and 2.2 VTIs per patient in the first 7 years of observation [20,44,59,66]. Cleft defects play an important role in OME formation; therefore, it would be reasonable to assume a higher need for grommets in children with more overt palatal malformations.…”

Section: Frequency Of Grommet Insertionmentioning

confidence: 99%

“…Compared to healthy children, children with CLP are more susceptible to OME [3]. Despite the fact that the vast majority of patients (about 80%) do not have OME at birth [4], statistics show that OME occurs…”

Section: Introductionmentioning

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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Treatment of persistent middle ear effusion in cleft palate patients

Cited by 59 publications

References 11 publications

Clinical outcomes of ventilation tube placement in children with cleft palate

Clinical outcomes of ventilation tube placement in children with cleft palate

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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