Otological outcome in cleft lip and palate children with middle ear effusion

Azman, Ali; Manuel, Anura Michelle

doi:10.1016/j.ijporl.2020.110274

Cited by 19 publications

(26 citation statements)

References 24 publications

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“…A single article [18] failed to achieve statistical significance in its (albeit positive) results and suggested age as a major confounder for the results in this population. This objection has been indeed confirmed by studies confirming that middle ear disease in CP±L children tends to improve with age [5].…”

Section: Discussionmentioning

confidence: 75%

“…There is nevertheless a specific area of intervention where adenoidectomy could represent a powerful additional tool that requires urgent investigation. Cleft patients requiring re-tympanostomy (a population with a known higher risk of long-term otologic sequelae [5]) might benefit from concurrent tympanostomy and adenoidectomy to lower the risk of further tympanostomies. Prospective RCT of partial adenoidectomy in these patients would be feasible, ethical, and might hold great potential.…”

Section: Discussionmentioning

confidence: 99%

“…There is a consensus among clinicians and studies that early ventilation tube insertion and early surgical cleft repair allow favorable results in this population [5]. Nevertheless, the role of repeated grommet insertion has been shown to correlate (albeit with a possible consistent selection bias) with a higher prevalence of chronic otitis media [5] in a population already at a higher incidence of re-tympanostomy when compared to non-cleft children. [6] In the general pediatric population suffering from OME and RAOM there is conspicuous, albeit often lowlevel, evidence for the role of adenoidectomy and/or tympanostomy for OME, ORCHL, and RAOM.…”

Section: Objectivementioning

confidence: 99%

See 2 more Smart Citations

Did we get lost in the Seventies? Adenoidectomy for middle ear disease in cleft palate children: a systematic review.

Rosso

Bulfamante

Pipolo

et al. 2021

Preprint

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OBJECTIVES: Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group is scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at filling this knowledge gap by collecting the available evidence on this subject, to frame possible further areas of research and interventions. DESIGN: A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. RESULTS: Among 321 unique citations, 3 studies were deemed eligible (2 case series and a retrospective cohort study). The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution (this last result being not statistically significant). CONCLUSION: Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data is therefore available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

See 1 more Smart Citation

Did we get lost in the Seventies? Adenoidectomy for middle ear disease in cleft palate children: a systematic review.

Rosso

Bulfamante

Pipolo

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…A single article [ 18 ] failed to achieve statistical significance in its positive results and suggested age as a major confounder for the results in this population. Recent studies have indeed confirmed that that middle ear disease in CP ± L children tends to improve with age [ 5 ].…”

Section: Methodsmentioning

confidence: 86%

“…Studies suggest that both early tympanostomy and early surgical cleft repair lead to favorable audiological results in this population [ 5 ]. Nevertheless, the role of repeated tympanostomy has been shown to correlate (though with a possible consistent selection bias) with a higher prevalence of chronic otitis media [ 5 ] in a population already at a higher incidence of re-tympanostomy when compared to non-cleft children [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Adenoidectomy for middle ear disease in cleft palate children: a systematic review

Rosso

Bulfamante

Pipolo

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose Cleft palate children have a higher incidence of otitis media with effusion, more frequent recurrent acute otitis media episodes, and worse conductive hearing losses than non-cleft children. Nevertheless, data on adenoidectomy for middle ear disease in this patient group are scarce, since many feared worsening of velopharyngeal insufficiency after the procedure. This review aims at collecting the available evidence on this subject, to frame possible further areas of research and interventions. Methods A PRISMA-compliant systematic review was performed. Multiple databases were searched with criteria designed to include all studies focusing on the role of adenoidectomy in treating middle ear disease in cleft palate children. After duplicate removal, abstract and full-text selection, and quality assessment, we reviewed eligible articles for clinical indications and outcomes. Results Among 321 unique citations, 3 studies published between 1964 and 1972 (2 case series and a retrospective cohort study) were deemed eligible, with 136 treated patients. The outcomes were positive in all three articles in terms of conductive hearing loss improvement, recurrent otitis media episodes reduction, and effusive otitis media resolution. Conclusion Despite promising results, research on adenoidectomy in treating middle ear disease in the cleft population has stopped in the mid-Seventies. No data are, therefore, available on the role of modern conservative adenoidectomy techniques (endoscopic and/or partial) in this context. Prospective studies are required to define the role of adenoidectomy in cleft children, most interestingly in specific subgroups such as patients requiring re-tympanostomy, given their known risk of otologic sequelae.

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The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study

Kazemi,

Nabavizadeh,

Nadjmi

et al. 2024

Laryngoscope Investig Oto

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ObjectiveOtitis media with effusion is common in children with cleft palates. This study aimed to investigate the link between palatal closure techniques and audiological outcomes.MethodsIn this retrospective‐prospective cohort study, we examined the relationship between palate repair techniques and hearing outcomes in children with cleft palates. From 2017 to 2022, 190 ears of 95 cleft patients were studied at the Cleft Lip and Palate Department of Shiraz University of Medical Sciences. Variables assessed included the surgical technique, cleft severity, auditory brainstem response (ABR) threshold, and tympanometry configuration.ResultsThe mean ABR improved from a prepalatoplasty value of 39.51(11.62) decibels (dB) to a postpalatoplasty mean of 26.61(11.60) dB (Cohen's d: 1.12 [95% CI; 0.90–1.34]). Initially, 87.9% of the studied ears exhibited abnormal tympanometry, but this significantly decreased to 47% postsurgery (risk ratio: 4.43 [95% CI; 1.20–16.43]). When compared with Sommerlad intravelar veloplasty, the Nadjmi modified Furlow palatoplasty was associated with a notably lower mean ABR (β: −6.58 [95% CI: −10.43 to −2.73], p‐value = .001) and a reduced frequency of abnormal tympanometry (odds ratio [OR]: −1.10; 95% CI: −1.85 to −0.36, p‐value = .004). Factors like prepalatoplasty ABR, cleft palate severity, gender, and syndromic did not confound these findings.ConclusionsAlthough the Nadjmi modified Furlow palatoplasty showed better results, our findings indicate a significant improvement in ABR and tympanometry outcomes for both techniques. Future randomized controlled trials are suggested to confirm the influence of palatal closure techniques on audiological outcomes.Level of Evidence3b.

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Otological outcome in cleft lip and palate children with middle ear effusion

Cited by 19 publications

References 24 publications

Did we get lost in the Seventies? Adenoidectomy for middle ear disease in cleft palate children: a systematic review.

Did we get lost in the Seventies? Adenoidectomy for middle ear disease in cleft palate children: a systematic review.

Adenoidectomy for middle ear disease in cleft palate children: a systematic review

The relationship between cleft palate repair technique and audiological outcomes: A retrospective cohort study

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