Grommets and speech at three and six years in children born with total cleft or cleft palate

Ezzi, Oumama El; Herzog, Georges; Broome, Martin; Trichet-Zbinden, Chantal; Hohlfeld, Judith; Cherpillod, Jacques; Roessingh, Anthony de Buys

doi:10.1016/j.ijporl.2015.10.012

Cited by 12 publications

(13 citation statements)

References 15 publications

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“…Studies Reporting on Outcome Timing of tympanostomy tube insertion Klockars and Rautio, 2012;Kobayashi et al, 2012;Brgoch et al, 2015;Fitzsimons et al, 2017;Kim et al, 2017;Shaffer et al, 2018;Yang et al, 2019Hearing outcomes Andrews et al, 2004Goudy et al, 2006;Knapik and Saliba, 2012;Ezzi et al, 2015;Imbery et al, 2017;Kim et al, 2017;Tengroth et al, Goudy et al, 2006;Ahn et al, 2012;Brgoch et al, 2015;Lehtonen et al, 2016;Fitzsimons et al, 2017;Imbery et al, 2017;Kim et al, 2017;Garcia-Vaquero et al, 2018;Kapitanova et al, 2018;Shaffer et al, 2018;Inoue et al, 2020Middle ear/otoscopic findings Goudy et al, 2006Reiter et al, 2009;Ahn et al, 2012;Knapik and Saliba, 2012;Kuşcu et al, 2015;Lehtonen et al, 2016;Imbery et al, 2017;Kim et al, 2017;Inoue et al, 2020 studies Mastoid air cell area Kobayashi et al, 2012 speech outcomes (Merrick et al, 2007;Ezzi et al, 2015) and 1 discussing language development (Ko...…”

Section: Discussionmentioning

confidence: 99%

Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care

Stanton

Kondra

Brahme

et al. 2022

The Cleft Palate Craniofacial Journal

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Objective To understand the indication for and the effects of early ventilation tube insertion (VTI) on hearing and speech for patients with cleft lip and/or palate (CLP). Design We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-guided systematic review of relevant literature. Setting Setting varied by geographical location and level of clinical care across studies. Patients, Participants Patients with CLP who underwent VTI were included. Interventions No interventions were performed. Main Outcome Measure(s) Primary outcome measures were hearing and speech following VTI. Secondary outcome measures were tube-related and middle ear complications. Early VTI occurred before or at time of palatoplasty while late VTI occurred after palatoplasty. Results Twenty-three articles met inclusion criteria. Articles varied among study design, outcome measures, sample size, follow-up, and quality. Few studies demonstrated support for early VTI. Many studies reported no difference in hearing or speech between early and late VTI. Others reported worse outcomes, greater likelihood of complications, or needing repeat VTI following early tympanostomy placement. Several studies had significant limitations, including confounding variables, small sample size, or not reporting on our primary outcome. Conclusions No consistency was found regarding which patients would benefit most from early VTI. Given the aforementioned variability and sub-optimal methodologies, additional studies are warranted to provide stronger evidence regarding VTI timing in cleft care.

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Section: Discussionmentioning

confidence: 99%

Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care

Stanton

Kondra

Brahme

et al. 2022

The Cleft Palate Craniofacial Journal

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“…The surgical insertion of a tympanostomy/ventilation tube (grommet) allows the fluid to drain, and thus provides aeration and equalization of pressure in the middle ear cavity. This explains why children with cleft palate and grommets have better language acquisition and prognosis than the children with cleft palate and no grommets [31,32].…”

Section: Discussionmentioning

confidence: 99%

Palatal cleft: Results after 18 years, one surgeon, one primary technique

Roessingh¹,

Medinger²,

Broome³

et al. 2020

Otorhinolaryngol Head Neck Surg

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This study reviews the results after 18 years of our surgery and follow-up for children born in our hospital with a cleft palate (CP). Evaluation of 18-year-old youngsters born with CP, operated at the time by the same surgeon following the same primary surgical procedure (von Langenbeck). We analyzed the files of children born from 1997 to 2001 with a CP and operated in our hospital. Operations were performed by the same surgeon, following the von Langenbeck procedure adapted according to the children's age or weight. The evaluation was based on the results of the primary surgeries, final phonatory results, otorhinolaryngology interventions, maxillofacial surgery, and psychological needs. All syndromic children were excluded. Seventy-nine files from children born with a cleft were reviewed: 34 were taken into consideration and among them five Pierre Robin Sequence (PRS) were removed. Children were operated at a median age of 5,2 months (3-6). Eighteen percent had a fistula, 45% had grommets, 14% were operated for a pharyngeal flap following the Sanvenero-Rosselli technique to improve the phonatory score. Thirty-six (36) percent had a final phonation I, 32% a phonation I/II and 32% a phonation IIb. None had an osteotomy. All children were seen by our psychologist. A median of 5.5 multidisciplinary consultations were affected with a median number of general anesthesia of 2.4 (1-6).This retrospective study is based on one primary surgical technique used by the same surgeon. It shows that the von Langenbeck procedure done at six months entails a certain risk of fistula but shows good long-term phonatory results. The number of grommets used is low and must be seen in relation with otitis media and our follow-up. A few complements to our investigations and follow-up are proposed concerning grommets, surgical procedures, and sleep disorder.

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“…As regard tympanosclerosis: Pooling of the five studies (6,7,10,11,13) using a random effects model showed an odds ratio of 4.671 with a 95% CI of 0.494 to 44.136 which was not statistically significant (p-value, 0.179) denoting equivalence of both management strategies. 79.41% 95% CI for I 2 51.17 to 91.32…”

Section: C-tympanosclerosismentioning

confidence: 92%

Conservative Management versus Ventilation Tube Insertion in Children with Otitis Media with Effusion Accompanying Cleft Palate

Masoud

El-Kahky

Hassan

et al. 2017

EJHM

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Background: Otitis media with effusion (OME) is a collection of non-purulent fluid in the middle ear space; it is almost universal in children with cleft palate. Cleft palate (CP) is among the most common congenital malformations, with an overall incidence of around 1 in 700 individuals. Surgical closure of the cleft palate may lead to improvement in the audiological status of the patients, but whether early surgical correction can improve the middle ear status in CP children remains open for debate. Aim: A meta-analytical study to evaluate and compare the outcome of ventilation tube insertion versus conservative management in management of otitis media with effusion accompanying cleft palate. Methods: A review process was used to assess eligible studies drawn from included published medical articles about conservative management versus ventilation tube insertion in children with otitis media with effusion accompanying cleft palate through searching the Medline data base (www.pubmed.com) and Cochrane library. Then Data were extracted and analyzed from the included studies. Results: 30 relevant articles were found, by application of inclusion criteria 8 articles were found meeting the inclusion criteria and could undergo Meta-analysis. Our results have shown that OME in children with repaired cleft palate can be managed satisfactorily without routine use of ventilation tube (VT). The presence of OME does not lead to long term complications in all patients. Hearing impairment due to OME can be satisfactorily treated with hearing aid (HA) in a majority of children. VT need to be inserted only if the child is not compliant with using a HA or develops recurrent suppurative otitis media. Patients should be followedup closely for OME to prevent complications. Conclusion: Routine use of ventilation tube in CP patients should be discouraged; instead Treatment should be based on the need and willingness of the children and their parents. Also with respect to individual bases such when the child is proved to have OME and hearing loss that affect child language and speech development. Insertion of ventilation tubes should be offered as an alternative to hearing aids or conservative management by close otological and audiological follow up.

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Grommets and speech at three and six years in children born with total cleft or cleft palate

Cited by 12 publications

References 15 publications

Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care

Tympanostomy Tubes: Are They Necessary? A Systematic Review on Implementation in Cleft Care

Palatal cleft: Results after 18 years, one surgeon, one primary technique

Conservative Management versus Ventilation Tube Insertion in Children with Otitis Media with Effusion Accompanying Cleft Palate

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