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

• Published in: International journal of pediatric otorhinolaryngology 2013-09, Vol.77 (9), p.1518-1522
• Main Authors: Carroll, Daniel J, Padgitt, Noëlle R, Liu, Meixia, Lander, Timothy A, Tibesar, Robert J, Sidman, James D
• Format: Article
• Language: English
• Subjects: Age Factors; Audiometry - methods; Auditory Threshold - physiology; Child; Child, Preschool; Cleft palate; Cleft Palate - complications; Cleft Palate - surgery; Cohort Studies; Conductive hearing loss; Eustachian tube; Female; Follow-Up Studies; Hearing Loss, Conductive - etiology; Hearing Loss, Conductive - prevention & control; Hearing Tests; Humans; Male; Otitis Media with Effusion - etiology; Otitis Media with Effusion - prevention & control; Otolaryngology; Otoscopy - methods; Palatoplasty; Pediatric; Pediatrics; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Recovery of Function; Retrospective Studies; Risk Assessment; Sex Factors; Technique; Time Factors; Treatment Outcome
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2013.06.021

Abstract Objective Otitis media with effusion causing conductive hearing loss is a problem for many children with cleft palate. This study examines the association between palate repair technique and hearing outcomes in children at 3 and 6 years post-repair. Patients and methods Retrospective chart review of patients with all types of cleft palate that were repaired between 2001 and 2006 at a tertiary children's hospital. Exclusion criteria included sensorineural hearing loss, ossicular chain abnormalities, and ear canal abnormalities. The primary outcome was pure tone average (PTA) from 0.5 kHz to 2 kHz. Results 69 patients (138 ears) were analyzed. 30.4% of left ears and 31.9% of right ears had an abnormal (>20 dB) PTA at 3 years; at 6 years this significantly improved to 13.0% ( p = 0.008) and 15.9% ( p = 0.011). Double-reverse z-plasty was associated with the lowest median PTA of 10.0 dB ( p = 0.046) at 6 years. There was no difference in median PTA between children with and without comorbid diagnoses (such as Pierre Robin Sequence, arthrogryposis) at either 3 years or 6 years ( p = 0.075, p = 0.331). Multivariate model showed that extent of cleft influenced technique choice ( p = 0.027), but only technique choice was associated with significant differences in PTA and only at 6 years post-repair. Conclusion The majority of children developed normal hearing by 6 years with palatoplasty and routine tube insertion. Double reverse z-plasty was associated with the best outcome, but is not ideal for hard palate clefts. Randomized controlled trials are needed to elucidate the relationship between technique, middle ear ventilation and time to recovery, irrespective of type of cleft.