Otolaryngology Service Usage in Children With Cleft Palate

Whittemore, Kenneth R.; Dargie, Jenna M.; Dornan, Briana K.; Boudreau, Brian

doi:10.1177/1055665617752210

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…19 The majority of cleft palate and Down syndrome patients will receive TT replacement (55%-89%) 5,6,[20][21][22] and many will receive multiple replacements (34%-50%). 20,21,23 Male sex was a significant predictor of r-TT in this review, with most patients drawn from a large database study by Beyea et al 4 However, theirs was the only one of the six analyzed studies to find a significant association of sex and r-TT, and in a repeat analysis excluding this study, this association did not persist. Younger patients have also been noted in multiple studies to have higher rates of r-TT.…”

Section: Discussionmentioning

confidence: 50%

Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta‐Analysis

et al. 2020

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Objectives/Hypothesis: To determine the rate and predictors of receiving multiple tympanostomy tube (TT) placements in children.Study Design: Systematic review and meta-analysis. Methods: PubMed, EMBASE, and Cochrane Library databases were searched for studies reporting the risk factors for receiving repeat TT (r-TT) placements in children with chronic otitis media with effusion or recurrent acute otitis media. These articles were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Data were pooled using a random-effects model.Results: Twenty-one studies involving a total of 290,897 children were included. Among all patients, 24.1% (95% confidence interval (CI), 18.2%-29.9%) underwent ≥2 TT placements and 7.5% (95% CI, 5.7%-9.4%) underwent ≥3 TT placements. Craniofacial disease (odds ratio (OR) 5.13, 95% CI, 1.57-16.74) was the strongest predictor of r-TT. Younger age at initial TT placement and shorter TT retention time were also significantly associated with r-TT. Receipt of primary adenoidectomy with initial TT placement was associated with decreased odds of r-TT (OR, 0.46; 95% CI, 0.39-0.55). Long-term tubes also significantly reduced the odds of r-TT (OR, 0.27; 95% CI, 0.17-0.44).Conclusions: About 1 in 4 children receiving TT will receive at least one repeat set of TT and about 1 in 14 will receive multiple repeat sets. Concurrent adenoidectomy and long-term tubes reduced the incidence of r-TT. Younger patients and those with earlier extrusion of the initial set are at increased risk for repeat surgery. The identification of these risk factors may improve parental counseling and identify patients who might benefit from closer follow-up.

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Section: Discussionmentioning

confidence: 50%

Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta‐Analysis

et al. 2020

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“…Special patient populations exhibit high incidence of otolaryngologic disease with resultant high utilization of common surgery. For example, children with cleft palate have near‐universal Eustachian tube dysfunction requiring tympanostomy tubes usually more than once 12 and children with Down syndrome commonly have ear disease as well as obstructive sleep disorders that lead to frequent adenotonsillectomy and/or placement of tympanostomy tubes 13 . Achondroplasia is a skeletal dysplasia with craniofacial structural anomalies and neuromotor abnormalities that impair Eustachian tube function and cause sleep‐related upper airway obstruction 14 …”

Section: Discussionmentioning

confidence: 99%

Otolaryngology Utilization in Patients With Achondroplasia: Results From the CLARITY Study

et al. 2021

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Objectives/Hypothesis: To quantify otolaryngologic surgery utilization in patients with achondroplasia, and to identify any changes in utilization over the past four decades.Study Design: Retrospective cohort study.Methods: A retrospective cohort study of 1,374 patients with achondroplasia enrolled in the CLARITY retrospective cohort study at four centers of multi-specialty care for patients with achondroplasia. Otolaryngologic surgeries are presented by birth cohort decade. The main outcomes were number of primary and additional otolaryngologic procedures; age at surgery; likelihood of repeated surgery; temporal trends in surgical utilization.Results: In this cohort of 1,374 patients with achondroplasia, 620 (45.1%) had pharyngeal surgery at least once, 150 (10.9%) had pharyngeal surgery on more than one occasion, and patients who had adenoidectomy first were 2.68 times more likely to require a second pharyngeal surgery than those who had adenotonsillectomy. Seven hundred and seventy-nine (56.7%) had tympanostomy tubes placed at least once, and 447 (32.5%) had tympanostomy tubes placed more than one time. Age at first pharyngeal surgery decreased by 1.2 years per birth cohort decade, and age at tympanostomy tube placement decreased by 1.1 years per decade.Conclusions: Patients with achondroplasia often require otolaryngologic surgery, particularly adenoidectomy and/or tonsillectomy as well as tympanostomy tube placement. Such surgery is performed now more frequently and at younger ages than in earlier decades. While otolaryngologic disease associated with achondroplasia is now recognized earlier and treated more frequently, long-term outcome studies are needed.

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“…It is widely known that children with cleft palate with or without cleft lip (CL/P) are prone to eustachian tube dysfunction and related hearing loss (Bess et al, 1976; Fria et al, 1987; Schönweiler et al, 1999). Fluctuant mild to moderate conductive hearing loss is most prevalent and hearing loss can persist through late toddlerhood (Tengroth et al, 2017; Whittemore et al, 2018). Hearing loss tends to resolve with age and decreased incidence of middle ear dysfunction; however, hearing loss can persist through early school age (Thanawirattananit & Prathanee, 2016; Werker et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Hearing loss tends to resolve with age and decreased incidence of middle ear dysfunction; however, hearing loss can persist through early school age (Thanawirattananit & Prathanee, 2016; Werker et al, 2018). Additionally, both mixed and sensorineural hearing loss are possible in this population and are usually associated with comorbid genetic and/or syndromic conditions (Vlastos et al, 2009; Whittemore et al, 2018). Given the ear and hearing-related consequences, otolaryngologists and audiologists have been deemed essential professionals within the multidisciplinary cleft/craniofacial team (Capone & Sykes, 2007; Lewis et al, 2017; American Cleft Palate-Craniofacial Association, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Whittemore et al (2018) has previously reported on the usage of otolaryngology services by children with CP, averaging 8.2 visits within the first 5 years of life and undergoing a mean of 3.3 tympanostomy tube surgeries within the same time period. Although hearing loss at a child’s final audiologic evaluation was reported in 34.8% of this cohort, very little information regarding audiologic services was provided within the time period included in the study.…”

Section: Introductionmentioning

confidence: 99%

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Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative

Findlen

Grischkan

Alston

et al. 2021

The Cleft Palate Craniofacial Journal

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Objective: To evaluate and increase adherence to an evidence-based audiologic management protocol for children with cleft palate. Design: Prospective, multidisciplinary quality improvement initiative. Setting: Tertiary pediatric hospital. Patients, Participants: Children with cleft palate (with or without cleft lip) between the ages of 0 and 5 years (n = 205). Interventions: A multidisciplinary team identified key drivers for nonadherence to recommended audiological follow-up and implemented interventions to improve adherence. Key drivers included provider practices and preferences, clinic logistics and flow, and patient/family awareness and education. Several interventions were implemented between 2016 and 2020, including developing an evidence-based audiologic protocol, maximizing access to audiologic clinic visits across multiple departments, cleft team education, and improved team communication. Main Outcome Measure(s): Completion of recommended audiologic assessment at 5 separate care milestones. Results: After implementation of interventions between 2016 and 2020, adherence to recommended audiologic follow-up increased from 59% to 84%. Analysis of individual care milestones revealed that increased access to audiologic testing during team clinics resulted in the largest increase in adherence to recommended follow-up. Additionally, cause-effect analysis revealed that nonadherence due to provider-related causes decreased over the project period to a greater extent than patient/family-related causes. Conclusions: Implementation of an evidence-based audiologic care protocol and improvements in access to early hearing care are feasible in a high-volume multidisciplinary cleft clinic. Adherence to recommended audiologic management can be improved by establishing strategies to improve access to care, team member and family education, and enhanced team communication.

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Otolaryngology Service Usage in Children With Cleft Palate

Cited by 5 publications

References 19 publications

Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta‐Analysis

Risk Factors for Multiple Tympanostomy Tube Placements in Children: Systematic Review and Meta‐Analysis

Otolaryngology Utilization in Patients With Achondroplasia: Results From the CLARITY Study

Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative

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