Grommet Surgery in Children with Orofacial Clefts in England

Abstract

Intervention: Children receiving grommets before the age of five. Outcome measures:The proportion of children receiving grommets before the age of five, the timing of the first grommet insertion and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socio-economic deprivation, and region of residence.Results: 8,269 children were included. Before the age of five, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between six and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% vs. 4.5%).Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socio-economic deprivation, and region of residence. Conclusion:Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.

Benchmarking Speech, Velopharyngeal Function Outcomes and Surgical Characteristics Following the Sommerlad Protocol and Palate Repair Technique

“…Hearing. The number of participants who had grommets inserted (41%) is high compared with 18.9% reported by Gani et al (2012), but similar to the 39.3% reported by D'Andrea et al 2018after the Sommerlad technique and 45.5% reported on national UK data by Fitzsimons et al (2017). The high numbers of grommet insertion reported in this study reflects historical practice.…”

“…The high numbers of grommet insertion reported in this study reflects historical practice. Current practice favors more conservative management with hearing aids (Ness et al, 2015; Fitzsimons et al, 2017). Gani et al (2012) reported that iCP+PRS was the most commonly affected additional condition requiring hearing intervention with 47% requiring hearing aids or grommets.…”

School absence and achievement in children with isolated orofacial clefts

“…Our results demonstrate that both cleft type and school absence are independently associated with academic attainment in children with a cleft.InterpretationDifferences in annual school absence levels between 7-year-old children with an isolated orofacial cleft and corresponding children in the general population are due to differences in length of absence for illness and medical/dental appointments. This is in line with our previously published observations that children with more complex cleft types require more interventions from multiple specialties, including grommets insertions and dental procedures requiring general anaesthetic [3,7].…”

“…We did not find evidence that the differences in school absence explain poorer levels of It has been suggested that specific cleft-related factors, such as deficiencies in hearing and speech as well as other learning difficulties, such as attention disorder and dyslexia, may contribute to the observed attainment gap. [3,21] We found that 40% of the 7-year-old children with an isolated cleft received SEN support which is even higher than the 25% we observed in our previous study in 5-year-olds. [10] Even children with CLO were found to have higher levels of SEN provision compared with the general population (26.7% compared to 20.9%).…”

“…. [1] A cleft can affect hearing, [2,3] language, [4,5] dental health, [6,7] psychosocial health, [8] neurodevelopmental health, [9] and academic outcomes. [9,10] Recently, we have shown that the presence of an isolated cleft (a cleft without additional anomalies or syndromes) negatively affects all areas of learning, especially when the cleft involves the palate (both CPO and CLP).…”