Third Place — Resident Clinical Science Award 1994: Recovery of Eustachian Tube Function and Hearing Outcome in Patients with Cleft Palate

Abstract

Eustachian tube dysfunction is a nearly universal complication of cleft palate, resulting in chronic ear disease and conductive hearing loss. Cleft palate repair is thought to result in recovery of eustachian tube function, but the length of time between repair and recovery of eustachian tube function is not known. Furthermore, the efficacy of tympanostomy tubes in the treatment of eustachian tube dysfunction and hearing sequelae has not been examined in a systematic way. To answer these questions, we performed a retrospective study that used serial audiometric data and tympanometry on 81 patients with cleft palates (162 ears), with follow-up ranging from 1 to 17.3 years. Average time to recovery of eustachian tube function was 6.0 years (range, 1.0 to 10.3 years) after cleft palate surgery. For children followed up for at least 6 years (longest follow-up, 17.3 years), 70% (67 of 85) had normal eustachian tube function at their last follow-up visit. Ears treated with Armstrong tympanostomy tubes required an average of 3.1 tubes per ear until recovery of eustachian tube function, whereas ears treated with Goode T tubes required only 1.1 tubes per ear (p < 0.05). Hearing evaluation revealed that 67% of ears had abnormal hearing thresholds (> 20 dB) before tympanostomy tube placement, whereas only 7.5% of ears demonstrated this loss after tube placement. Furthermore, more than 90% of ears maintained normal thresholds after recovery of eustachian tube function. These data indicate that most children with cleft palates eventually recover normal eustachian tube function after palatoplasty, but for the majority of children, this does not occur for many years.(ABSTRACT TRUNCATED AT 250 WORDS)

Tympanostomy Tube Placement for Otitis Media with Effusion in Children with Cleft Lip and Palate

“…RynnelDagoo et al found that 82% of the CLP children with or without OME had a normal hearing at 3-4 years of age, indicating recovery from OME [42]. Smith et al found that the Eustachian tube function of most children with CLP significantly improved by 6-7.5 years of age [43].…”

“…A number of researchers have reported that OME and Eustachian tube function improve as the patient grows older [41,43,44], recommending watchful waiting for CLP children with OME for a period of 3-6 months from the diagnosis of effusion [41,[43][44][45]. During the observation period, patients can wear hearing aids to attain the same hearing performance of children with ventilation tubes [45]; however, it should be noted that children may find hearing aids inconvenient or may worry about the social stigma associated with wearing such aids [27,46].…”

“…Hearing outcomes were evaluated in several case-series studies [16,23,43,[53][54][55][56][57]. Over the long term, between 50 and 94% of CLP children recovered normal hearing after being administered VTI in conjunction with palatoplasty (follow-up 5.5-15.4 years) [16,43,[54][55][56][57].…”

“…Over the long term, between 50 and 94% of CLP children recovered normal hearing after being administered VTI in conjunction with palatoplasty (follow-up 5.5-15.4 years) [16,43,[54][55][56][57]. Furthermore, children requiring a higher number of VTIs were at increased significant risk for long-standing hearing loss [16,23].…”

“…More than half (50-94%) of CLP children recovered normal hearing 5-15 years after VTI [16,43,[54][55][56][57]. Moreover, compared with conservative management, most studies have shown that VTI is beneficial to hearing recovery over the short as well as long term [60,[64][65][66]68].…”