Otologic, audiometric and speech findings in patients undergoing surgery for cleft palate

Abstract

BackgroundAlthough considerable progress has been made in the last 30 years in the treatment of cleft palate (CP), a multidisciplinary approach combining examinations by a paediatrician, maxillofacial surgeon, otolaryngologist and speech and language pathologist followed by surgical operation is still required. In this work, we performed an observational cross-sectional study to determine whether the CP grade or number of ventilation tubes received was associated with tympanic membrane abnormalities, hearing loss or speech outcomes.MethodsOtologic, audiometric, tympanometric and speech evaluations were performed in a cohort of 121 patients (children > 6 years) who underwent an operation for CP at the Vall d’Hebron Hospital, Barcelona from 2000 to 2014.ResultsThe most and least frequent CP types evaluated according to the Veau grade were type III (55.37%) and I (8.26%), respectively. A normal appearance of the membrane was observed in 58% individuals, of whom 55% never underwent ventilation ear tube insertion. No statistically significant associations were identified between the CP type and number of surgeries for insertion of tubes (p = 0.820). The degree of hearing loss (p = 0.616), maximum impedance (p = 0.800) and tympanic membrane abnormalities indicative of chronic otitis media (COM) (p = 0.505) among examined patients revealed no statistically significant association with the grade of CP. However, an association was identified between hypernasality and the grade of CP (p = 0.053), COM (p = 0.000), hearing loss (p = 0.000) and number of inserted ventilation tubes.ConclusionAlthough the placement of tympanic ventilation tubes has been accompanied by an increased rate of COM, it is still important to assess whether this is a result of the number of ventilation tubes inserted or it is intrinsic to the natural history of middle ear inflammatory disease of such patients.Our results do not support improvements in speech, hearing, or tympanic membrane abnormalities with more aggressive management of COM with tympanostomy tubes.

The Relationship between the Type of Cleft and Nasal Air Emission in Speech of Children with Cleft Palate or Cleft Lip and Palate

“…It has been proven that the results obtained in our research are, to a certain level, compatible with the results obtained in other research, but also different at times. Kaewkumsan et al,[16], who examined the degree of hypernasality and formation of an oronasal fistula in 40 patients, aged between 5 and 6,9 years, with non-syndromic cleft palate with or without cleft lip, established that the patients with cleft Class IV and Class III (according to the Veau classification) had a higher total score for hypernasality than patients with Class I. Garcia-Vaquero et al, [17] conducted research about the hearing and speech of 121 patients aged above 6 who had already undergone intervention of the cleft palate. Among other things they also examined the relation between Veau classification and hypernasality.…”

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

“…Average age was reported differently amongst the studies, organized either by age at first tube placement, age at lip or palate repair, age at time of study, and age at myringoplasty. Study subjects originated from 13 countries: Canada (Knapik and Saliba, 2012), Finland (Klockars and Rautio, 2012; Lehtonen et al, 2016), France (Rieu-Chevreau et al, 2019), Germany (Reiter et al, 2009), Japan (Kobayashi et al, 2012; Inoue et al, 2020), Taiwan (Yang et al, 2019), Turkey (Kuşcu et al, 2015), South Korea (Ahn et al, 2012), Spain (Garcia-Vaquero et al, 2018), Sweden (Tengroth et al, 2017), Switzerland (Ezzi et al, 2015; Kapitanova et al, 2018), the United Kingdom (Andrews et al, 2004; Merrick et al, 2007; Fitzsimons et al, 2017), and the United States (Goudy et al, 2006; Brgoch et al, 2015; Imbery et al, 2017; Kim et al, 2017; Shaffer et al, 2018; Koempel et al, 2021). More than half (13/23) of these studies were conducted using a retrospective cohort study design; the remaining studies consisted of 4 retrospective case series (Merrick et al, 2007; Imbery et al, 2017; Tengroth et al, 2017; Koempel et al, 2021), 3 cross-sectional studies (Andrews et al, 2004; Brgoch et al, 2015; Garcia-Vaquero et al, 2018), 2 case-control studies (Merrick et al, 2007; Inoue et al, 2020), and 1 prospective cohort study (Kobayashi et al, 2012).…”

“…Of note, no data was presented regarding the reason for additional VTI in relation to hearing or speech outcomes. The remaining 2 studies also failed to investigate timing of VTI in relation to hearing and speech, and consequently, provided no insight into our main outcome measure (Andrews et al, 2004; Garcia-Vaquero et al, 2018).…”

“…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...…”

Long-term Outcome of the Management of Otitis Media with Effusion in Children with and Without Cleft Palate Using the House-brand Polyethylene Ventilation Tube Insertion

“…Also, the type of cleft palate has been reported to have no association with the number of ventilation tube insertions. 6 Children with cleft palate are more prone to otitis media with effusion (OME) than children without cleft palate. Previous studies reported that children with cleft palate had an onset of OME in infancy with prolonged effusion, higher incidence of complications and hearing loss from chronic OME.…”