The effect of intervelar veloplasty under magnification (Sommerlad’s Technique) without tympanostomy on middle ear effusion in cleft palate patients

Abstract

Objective Different surgical techniques and management approaches have been introduced to manage the cleft palate (CP) and its complications, such as otitis media with effusion (OME) and auditory problems. The optimal method, as well as the ideal time for palatoplasty and ventilation tube insertion, are the subject of controversy in the literature. We aimed to evaluate The Effect of Intervelar Veloplasty under Magnification (Sommerlad’s Technique) without Tympanostomy on Middle Ear Effusion in Cleft Palate Patients. Methods non-syndromic cleft palate patients from birth to 24 months who needed primary palatoplasty from April 2017 to 2019 were enrolled in this study. intravelar veloplasty (IVVP) surgery under magnification has been done by the same surgeon. Likewise, Otoscopy, Auditory Brainstem Response (ABR), and tympanometry were performed for all the patients before and six months after palatoplasty. Results Tympanograms were classified into two categories according to shape and middle ear pressure, and it was done in 42 children (84 ears). Type B curve was seen in 40 cases (80 ears) before surgery which reduced significantly (P < 0.005) to 12 cases in the left ear and 14 cases in the right ear after surgery. So, after surgery, 70 % of the tympanogram of left ears and 66.6 % of the tympanogram of Rt ears were in normal condition (type A tympanometry). ABR was done for 43 patients (86 ears) before surgery and six months after palatoplasty. Data were shown that 40 of the patients had mild to moderate hearing loss before surgery, which reduced significantly (P < 0.005) to 9 in the left ear and 11 in the right ear after palatoplasty. So, after surgery, 79 % of ABR of left ears and 73.8 % of ABR of right ears were in normal status (normal hearing threshold). Conclusions Intervelar veloplasty under magnification (Sommerlad’s technique) significantly improved the middle ear effusion without the need for tympanostomy tube insertion.

Impact of a Modified Restoration of Tensor Veli Palatini on Hearing and Middle Ear Function in Cleft Palate Children—a Retrospective Study

“…Intergrouply, no difference was found either with ABR hearing threshold or 226-Hz tympanogram. The previous studies 9,11,12,14,[29][30][31][32] showed the special restoration of palatal muscles may or may not be beneficial to the hearing and the middle ear function. At least, it would not deteriorate the results.…”

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

“…One of the frequent complications, otitis media with effusion (OME), stands as the leading cause of conductive hearing loss in children with clefts. It tends to be both more prevalent and persistent compared with the general population 4–7 …”

“…It tends to be both more prevalent and persistent compared with the general population. [4][5][6][7] OME originates from the dysfunction of the eustachian tube, involving changes in para-tubal muscle architecture, tubal cartilage density, tubal curvature, and luminal diameter. These alterations facilitate inadequate ventilation and negative pressure within the middle ear cavity, culminating in OME and subsequent hearing loss.…”

The effect of Acellular Dermal Matrix on the success of primary palatoplasty with intravelar veloplasty

“…Following the closure of the palate layers, an intravelar veloplasty is performed to correct and change the position of the palatal muscles (5). Because of the improvements in palate performance, the patient's complaint about the complications decreases (6,7). If palate reconstruction is successful, the velopharyngeal area closes completely and the patient obtains the proper speech capability (6).…”