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The effect of cleft palate repair technique on hearing outcomes in children
Daniel J Carroll1, Noëlle R Padgitt, Meixia Liu
1University of Minnesota Medical School, Minneapolis, MN, USA. carrolldjm@gmail.com
Insights
Hearing loss in children with cleft palate improves by age 6. Double-reverse z-plasty technique showed the best hearing outcomes, though further research is needed.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Surgery
- Audiology
Background:
- Otitis media with effusion is a common cause of conductive hearing loss in children with cleft palate.
- This condition can significantly impact speech and language development.
- Early intervention and appropriate surgical techniques are crucial for optimal outcomes.
Purpose of the Study:
- To investigate the association between different palate repair techniques and hearing outcomes in children with cleft palate.
- To evaluate hearing at 3 and 6 years post-surgery.
- To identify surgical factors influencing hearing recovery.
Main Methods:
- Retrospective chart review of 69 patients with cleft palate repaired between 2001-2006.
- Exclusion of patients with sensorineural hearing loss or ear canal abnormalities.
- Primary outcome measure: pure tone average (PTA) from 0.5 kHz to 2 kHz.
Main Results:
- Hearing significantly improved from 3 to 6 years post-repair (abnormal PTA decreased from ~31% to ~15%).
- Double-reverse z-plasty technique was associated with the lowest median PTA (10.0 dB) at 6 years.
- Palate repair technique, not comorbid diagnoses, was the primary factor influencing PTA at 6 years.
Conclusions:
- Most children achieve normal hearing by 6 years after palatoplasty and tube insertion.
- Double-reverse z-plasty demonstrated superior hearing outcomes but may not be suitable for all cleft types.
- Further randomized controlled trials are necessary to confirm these findings and guide surgical choices.
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.
