The effect of cleft palate repair technique on hearing outcomes in children

Carroll, Daniel J.; Padgitt, Noëlle; Liu, Meixia; Lander, Timothy A.; Tibesar, Robert J.; Sidman, James D.

doi:10.1016/j.ijporl.2013.06.021

Cited by 34 publications

(50 citation statements)

References 6 publications

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“…Chronic Eustachian tube dysfunction today is a well‐recognized phenomenon in children with cleft palate for which the natural history is further characterized by the results of this study. Previous work has described effective use of proactive treatment of otitis media with effusion by routine placement of tympanostomy tubes in this patient population, but the length of time for which we should be proactive is not precisely known . It has been shown that middle ear disease, while widely prevalent in children with cleft palate ages 4 through 6 years, generally presents with a lower burden of disease by age 12 years .…”

Section: Discussionmentioning

confidence: 99%

“…Previous work has described effective use of proactive treatment of otitis media with effusion by routine placement of tympanostomy tubes in this patient population, but the length of time for which we should be proactive is not precisely known. [17][18][19][20] It has been shown that middle ear disease, while widely prevalent in children with cleft palate ages 4 through 6 years, generally presents with a lower burden of disease by age 12 years. 7 In a prior crosssectional analysis of children with cleft palate, Handzic-Cuk et al also demonstrated that the median age for type A tympanograms at their institution was 11 years.…”

Section: Discussionmentioning

confidence: 99%

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Eustachian tube dysfunction in children with cleft palate: A tympanometric time‐to‐event analysis

et al. 2019

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Objectives To characterize the duration of Eustachian tube dysfunction in children with cleft palate compared to those without cleft palate by performing time‐to‐event analysis on tympanometric data. To determine predictive characteristics of earlier achievement of normal tympanograms in children with cleft palate. Methods Longitudinal tympanometric data from a minimum of 10 years at a single center were reviewed for children with cleft palate born in the years 2003 through 2007. Children with cleft lip without cleft palate born in the same years were used as a reference group to compare children with similar length of follow‐up. The association between time to sustained normal (type A) tympanograms with patient demographics, clinical characteristics, and otologic history was evaluated using time‐to‐event analysis and compared with log rank tests. Adjusted and unadjusted hazard ratios were estimated using Cox proportional hazard models. Results The median age of achieving a type A tympanogram in children with cleft palate was 9.9 years for one and 12.1 years for both ears, compared to 7.1 and 7.4 years in children with cleft lip only (P < 0.0001). On multivariate analysis, clinical characteristics such as the severity of palatal clefting or the presence of a cleft‐associated syndrome/sequence were not predictors of a longer time to a type A tympanogram. Conclusion Our results help characterize the observation that there is delayed time to normal Eustachian tube function in children with cleft palate, which is not associated with the degree of palatal clefting. Level of Evidence 3b Laryngoscope, 130:1044–1050, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Eustachian tube dysfunction in children with cleft palate: A tympanometric time‐to‐event analysis

et al. 2019

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“…To define best management practices for OME in CP children, there is a recognized need for well-controlled, prospective, preferably blinded studies that evaluate the comparative efficacy of specified interventions intended to decrease future OME risk (Sadove et al, 2004; Carroll et al, 2013). Prerequisite to designing such studies is the need for a better description of the “typical” time-course for OME risk in CP children.…”

Section: Introductionmentioning

confidence: 99%

Resolution of Otitis Media with Effusion in Children with Cleft Palate Followed through Five Years of Age

Alper

Losee

Seroky

et al. 2016

The Cleft Palate Craniofacial Journal

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Objective Describe the temporal pattern of otitis media with effusion (OME) resolution for a cohort of non-syndromic cleft palate children enrolled before palatoplasty and followed through 5 years of age. Design Prospective, longitudinal study of the time course for OME resolution in infants and children with palatal clefts. Setting Cleft Palate Craniofacial Center of a tertiary care pediatric hospital. Participants Fifty-two children with cleft palate, 29 Male, 45 White, Veau 1–4 who had a Furlow-type palatoplasty between 10 and 24 months of age done by 1 of 6 surgeons. Interventions Standard cleft palate management supplemented by study visits to the research clinic pre- and post-palatoplasty and then yearly to age 6 years for assessments of middle ear status by interval history, otoscopy and tympanometry. Main Outcome Measure Age at otitis media resolution defined as the age in years at the first in a sequence of “disease-free” diagnoses not interrupted or followed by any other diagnosis. Results For ears/subjects, the cumulative percent OME resolution for ears/children at ages <1, 1, 2, 3, 4, 5 years was 4.1/4.4, 14.3/10.9, 31.6/21.7, 45.9/37.0, 56.1/50.0 and 70.4/60.9%. OME-resolution followed a simple linear time-curve with slopes of 13.5% (CI=12.2–14.8%, r2=0.99) and 11.9% (CI=10.1–13.6%, r2=0.99) resolutions per year for ears and children, respectively. Conclusions There is a natural, age-related pattern of resolution for the persistent OME that affects most infants and young children with cleft palate that is not affected by palatoplasty.

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“…Most eligible studies (91.3%) were published in the past 2 decades 4,6,7,12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 2). Most studies were conducted in Europe (43.5%) and 26.2% were conducted in the United States.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Without intervention, middle ear effusion causes conductive hearing loss. 6,7 In addition, impaired velopharyngeal closure has consequences on speech development.…”

mentioning

confidence: 99%

Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

Téblick

Ruymaekers

Casteele

et al. 2019

Journal of Oral and Maxillofacial Surgery

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Otitis media with effusion and disturbed speech are highly prevalent in children after cleft palate repair. Although many techniques for palatal closure have been described, no consensus has been reached on the most effective technique for these issues. The aim of this systematic review was to provide evidence-based information related to the effectiveness of different palatal closure techniques on middle ear and speech outcomes. Materials and Methods: A literature search in multiple electronic databases was performed: National Guidelines Clearinghouse, Trip Database, Cochrane Library, and Medline (PubMed). Potentially relevant articles were selected according to title and abstract and full-text eligibility. Then, quality control on the included articles was executed. Results: Twenty-three retrospective and prospective cohort studies were included in this systematic review. These studies compared at least 2 of the following techniques: von Langenbeck palatoplasty, 2-flap palatoplasty, Veau-Wardill-Kilner V-toY pushback technique, Kriens intravelar veloplasty, Sommerlad technique, Furlow double-opposing Z-plasties, and the Nadjmi modification of the Furlow palatoplasty. Their outcomes on the prevalence of otitis media with effusion, number of tympanostomy tubes placed, rates of hearing loss, and speech development were compared. Conclusions: The Sommerlad and Furlow palatoplasties were associated with the lowest prevalence of otitis media with effusion and the smallest number tympanostomy tubes needed. For hearing outcomes, the Furlow palatoplasty generated the best audiometric outcome. For speech outcomes, the Sommerlad and Furlow palatoplasties were more beneficial than the 2-flap palatoplasty, the Veau-Wardill-Kilner V-toY pushback technique, and the von Langenbeck palatoplasty. Additional randomized controlled trials are recommended to obtain evidence that can support these findings.

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The effect of cleft palate repair technique on hearing outcomes in children

Cited by 34 publications

References 6 publications

Eustachian tube dysfunction in children with cleft palate: A tympanometric time‐to‐event analysis

Eustachian tube dysfunction in children with cleft palate: A tympanometric time‐to‐event analysis

Resolution of Otitis Media with Effusion in Children with Cleft Palate Followed through Five Years of Age

Effect of Cleft Palate Closure Technique on Speech and Middle Ear Outcome: A Systematic Review

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