Prevalence of Tympanostomy Tube Placement in Relation to Cleft Width and Type

Abstract

Objectives/Hypothesis: The prevalence of tympanostomy tube surgery (TTS) in patients with a cleft deformity was investigated, in relation to cleft width and cleft type.Study Design: Retrospective review of medical health records. Methods: Retrospective review of medical health records. Seventy-eight patients with non-syndromic cleft deformity of the palate and/or alveolus and lip between 2003 and 2017 were investigated. All available medical documents were analyzed. The study group was divided into subgroups: 1) patients with isolated cleft palate (CP) and patients with a cleft palate with cleft lip and alveolus (CLP). 2) According to Veau's classification (I-IV), further subgroups were defined. Cleft width was measured using plaster cast models.Results: TTS was performed in 55% of the patients (n = 43). Considering Veau's classification, TTS was conducted as follows: Veau I 65.2% (n = 15/23), Veau II 55.0% (n = 11/20), Veau III 47.6% (n = 10/21), and Veau IV 50.0% (n = 7/14). Cleft classifications, maxillary arch width, and absolute/relative cleft width had no statistical impact on TTS occurrence. Although no significant correlation could be found, patients in our study group with CP (Veau I and II) underwent TTS more often (60.5%, n = 26/43) than patients with CPL (Veau III and IV; 48.6%, n = 17/35) during a three-year follow-up.Conclusion: None of the cleft characteristics examined had a significant impact on the proportion of patients who received TTS. Nevertheless, patients with lower Veau classification and CP received tympanostomy tubes more often. Therefore, otolaryngologists and pediatricians treating children with cleft palate should maintain a high level of suspicion for chronic middle ear effusion, even in patients with small clefts.

Relationship between cleft palate width and otitis media

“…To the best of our knowledge, the present study is the first to describe the relationship between cleft width and AOM incidence, the type and amount of middle ear effusion, OME duration, and age at OME resolution although some previous studies have reported the prevalence of VT 13 . Schwartz et al 13 for example, reported that the cleft type and width had no statistical association with VTI prevalence, in line with the findings of our study.…”

“…Several studies on the timing of VTI have reported that VT insertion before the age of 6 months is beneficial 12,14 although VTI before palatoplasty increases the risk of prolonged otorrhea. 15,16 The present study found no significant association between cleft Schwarz et al 13 explained that in patients with a wide cleft, the surgeon must mobilize tissue more extensively and perform the adaption under a higher tissue drag. The drag on the eustachian tube may increase in patients with a wider cleft, enabling better middle ear ventilation.…”

“…Schwarz et al 13 explained that in patients with a wide cleft, the surgeon must mobilize tissue more extensively and perform the adaption under a higher tissue drag. The drag on the eustachian tube may increase in patients with a wider cleft, enabling better middle ear ventilation.…”

Determination of Tympanostomy Tube Types for Otitis Media with Effusion in Patients with Cleft Palate: Comparison between Paparella Type 1 and Type 2 Tubes

“…This functional obstruction causes otitis media with effusion (OME) in children with CP, which compromises proper Eustachian tube opening. OME exhibits a high incidence rate in pediatric patients with CP [2][3][4][5].…”

“…While there is no doubt about the need for TTS in CP patients with OME, there is no consensus on the most appropriate size of the tube. Several factors, such as the classification of the defect or surgical technique, may affect the function of the Eustachian tube in patients with CP [4,11]. Therefore, the most appropriate size of the tube should be determined differently from TTS in patients without such defects.…”