The Effect of the Palatoplasty Method on the Frequency of Ear Tube Placement

Smith, Lynnelle K.; Gubbels, Samuel P.; MacArthur, Carol J.; Milczuk, Henry A.

doi:10.1001/archotol.134.10.1085

Cited by 35 publications

(38 citation statements)

References 21 publications

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“…A recent report from Smith et al suggests that children who underwent cleft repair with Furlow's double opposing z plasty technique had fewer ear tubes placed postoperatively than patients who had traditional repair. [16]…”

Section: Discussionmentioning

confidence: 99%

Problems of middle ear and hearing in cleft children

Sharma¹,

Nanda²

2009

Indian J Plast Surg

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The hearing loss in a cleft patient is a well known complication, but generally gets ignored. These children continue to have recurrent otitis media with effusion that affects the hearing abilities. Unfortunatley the middle ear function may not improve with palatoplasty.Cleft palate teams need to follow up all such children beginning at birth and going into adulthood, decades after a ‘successful’ palate repair. These patients should have careful otological and audiological surveillance with appropriate interventions whenever required. The review article discusses the current status of hearing management in patients with cleft palate.

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Section: Discussionmentioning

confidence: 99%

Problems of middle ear and hearing in cleft children

Sharma¹,

Nanda²

2009

Indian J Plast Surg

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“…In the few studies that evaluated ET function before and after palatoplasty, Bluestone and colleagues used the inflation-deflation test and reported an improved ability to reduce applied positive pressure after palatoplasty [14, 28], while Doyle and colleagues used that test and the FRT and reported no significant effect of palatoplasty on any test measure [22]. This discrepancy is mirrored in studies that evaluated the effect of palatoplasty on the time to cOME resolution where some studies reported no effect while others reported a positive effect of palatoplasty [3, 6–13]. …”

Section: Discussionmentioning

confidence: 99%

“…One of the complications of the CL/P condition is chronic otitis media with effusion (cOME) which is nearly universal in infant CL/P patients [2] and can persist throughout childhood [3, 4] and into adolescence [5, 6]. A number of studies have evaluated the effect of different palatoplasty methods on post-operative measures of cOME duration, but the results have been conflicting, even when evaluating the same surgical procedure [3, 6–13]. …”

Section: Introductionmentioning

confidence: 99%

Pre- and post-palatoplasty Eustachian tube function in infants with cleft palate

Alper

Losee

Mandel

et al. 2012

International Journal of Pediatric Otorhinolaryngology

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Objective One past study conducted in 1986 reported Eustachian tube dilation with swallowing during the forced response test (FRT) in a very high percentage (>80%) of cleft palate patients both before and after palatoplasty. The present study was designed to determine the reproducibility of those results. Methods The FRT was used to evaluate Eustachian tube function in a cohort of cleft palate children before and after palatoplasty. Pre-palatoplasty FRT data were available for 25 ears and post-palatoplasty data were available for 31 ears; 14 ears had paired pre-post palatoplasty test data. The results for the FRT tests were compared between the pre- and post-palatoplasty groups for the cross-sectional data and for the paired subset of ears. Results The 3 passive function measures of the FRT, the opening pressure, closing pressure and passive resistance were not different before and after palatoplasty for either data set. Similarly, 2 of the 3 active function measures, active resistance and dilatory efficiency, were not different pre- and post-palatoplasty, but the percent of ears evidencing tubal dilation for the cross-sectional data was 39% and 62% (P=NS) and for the paired subset was 33% and 83% (P=.04) at the pre- and post palatoplasty tests. Conclusion Palatoplasty had no effect on most measures of the FRT, but may have had a positive effect on the ability to dilate the Eustachian tube during swallowing. The high frequency of ears with tubal dilation before palatoplasty reported in the 1986 study was not reproduced but that frequency after palatoplasty was similar.

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“…Past studies comparing palatoplasty techniques (Guneren et al, 2000; Kane et al, 2000) have generally failed to demonstrate a clear impact of different palatoplasty techniques. In a retrospective analysis of 101 children followed through an average age of 4 to 5 years, Smith and colleagues (2008) observed significantly reduced need for tympanostomy tube placement in children treated with the FP compared with the VLP. The rationale for the difference between their findings and our observations is unclear.…”

Section: Discussionmentioning

confidence: 99%

Otologic and Audiologic Outcomes with the Furlow and von Langenbeck with Intravelar Veloplasty Palatoplasties in Unilateral Cleft Lip and Palate

Antonelli

Jorge

Feniman

et al. 2011

The Cleft Palate Craniofacial Journal

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Objective Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age. Design Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair. Setting Centralized, tertiary care craniofacial treatment center. Patients A total of 673 infants with unilateral cleft lip and palate. Interventions Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed. Main Outcome Measures Hearing and otoscopic findings at 5 to 6 years old. Results There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio = 5.1, 95% confidence interval = 1.44 to 18.11, p = .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations. Conclusions Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation.

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The Effect of the Palatoplasty Method on the Frequency of Ear Tube Placement

Cited by 35 publications

References 21 publications

Problems of middle ear and hearing in cleft children

Problems of middle ear and hearing in cleft children

Pre- and post-palatoplasty Eustachian tube function in infants with cleft palate

Otologic and Audiologic Outcomes with the Furlow and von Langenbeck with Intravelar Veloplasty Palatoplasties in Unilateral Cleft Lip and Palate

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