Grommets for otitis media with effusion in children with cleft palate: a systematic review

• Published in: Pediatrics (Evanston) 2014-11, Vol.134 (5), p.983-994
• Main Authors: Kuo, Chin-Lung, Tsao, Yuan-Heng, Cheng, Hao-Min, Lien, Chiang-Feng, Hsu, Chyong-Hsin, Huang, Chii-Yuan, Shiao, An-Suey
• Format: Article
• Language: English
• Subjects: Care and treatment; Child; Children; Children & youth; Cleft palate; Cleft Palate - diagnosis; Cleft Palate - epidemiology; Cleft Palate - surgery; Cohort Studies; Ear diseases; Health aspects; Hearing Loss - diagnosis; Hearing Loss - epidemiology; Hearing Loss - prevention & control; Humans; Middle Ear Ventilation - methods; Otitis media with effusion; Otitis Media with Effusion - diagnosis; Otitis Media with Effusion - epidemiology; Otitis Media with Effusion - surgery; Pediatrics; Randomized Controlled Trials as Topic - methods; Risk factors; Systematic review; Ventilation equipment; Vocabulary development
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2014-0323

No consensus has yet been reached with regard to the link between otitis media with effusion (OME), hearing loss, and language development in children with cleft palate. The objective of this study was to address the effectiveness of ventilation tube insertion (VTI) for OME in children with cleft palate. A dual review process was used to assess eligible studies drawn from PubMed, Medline via Ovid, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and reference lists between 1948 and November 2013. Potentially relevant papers were selected according to the full text of the articles. Relevant data were extracted onto a data extraction sheet. Nine high- or moderate-quality cohort studies were included in this study. VTI was administered in 38% to 53% of the OME cases, and more severe cases appeared more likely to undergo VTI. Compared with conservative forms of management (eg, watchful waiting), VTI has been shown to be beneficial to the recovery of hearing in children with cleft palate and OME. A growing body of evidence demonstrates the benefits of VTI in the development of speech and language in children with cleft palate and OME. These children face a higher risk of complications than those undergoing conservative treatments, the most common of which are eardrum retraction and tympanosclerosis, with an incidence of ∼ 11% to 37%. This review provides evidence-based information related to the selection of treatment for OME in children with cleft palate. Additional randomized controlled trials are required to obtain bias-resistant evidence capable of reliably guiding treatment decisions. The conclusions in this review are based on underpowered cohort studies and very-low-strength evidence.