Related Experiment Videos
Should Children With Cleft Palate Receive Early Long-Term Tympanostomy Tubes: One Institution's Experience
Amber D Shaffer1, Matthew D Ford2, Sukgi S Choi1
11 Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Insights
Children with cleft palate needing multiple tympanostomy tubes had shorter initial tube durations. This suggests a need for trials on early, long-term tube placement in this population.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Anomalies
Background:
- Children with cleft palate frequently experience otitis media with effusion.
- Tympanostomy tubes are commonly used to manage middle ear effusions in this population.
Purpose of the Study:
- To investigate the association between the number of tympanostomy tubes and the duration of the first tube placement in children with cleft palate.
- To evaluate the potential benefit of early, long-term tympanostomy tube insertion.
Main Methods:
- Retrospective cohort study of 105 children with cleft palate ± cleft lip treated at a tertiary care hospital.
- Analysis of tympanostomy tube replacement frequency and duration of the first tube.
Main Results:
- Children receiving multiple tympanostomy tubes had a significantly shorter duration of their first tube placement (19 months) compared to those with a single tube (26 months).
- Otorrhea was associated with a longer duration of the first tube, while perforation was not.
- Over half of the patients (55.3%) required tube replacement, with 34.0% receiving three or more sets.
Conclusions:
- Shorter initial tympanostomy tube duration is linked to the need for multiple tube placements in children with cleft palate.
- The high rate of repeat tube insertions and the prolonged need for tubes until school age highlight the necessity for prospective trials on early, long-term tympanostomy tube management.
Objectives:
To determine whether children with cleft palate might benefit from early long-term tympanostomy tubes with the hypothesis that receiving multiple tubes is associated with shorter duration of first tubes.
Design:
Retrospective cohort study.
Setting:
Tertiary care children's hospital.
Participants:
Records from 401 consecutive children with cleft palate ± cleft lip, born April 2005 to April 2010, were reviewed. After exclusion of children with cleft repair at an outside hospital, no follow-up after 5 years of age, intact secondary palate, no tubes, or tube replacement at palatoplasty, 105 children remained.
Main Outcome Measure:
Number of tubes.
Results:
Armstrong grommet tubes were placed at a median age of 6.7 months (range 2.3-19.6 months). Tubes were replaced in 55.3% of patients, with 34.0% receiving ≥3 sets. Duration of first tubes was significantly longer for children with 1 set of tubes compared with those with multiple sets (median 26 vs 19 months, P = .004). Otorrhea, but not perforation, was associated with longer duration of first tubes (median 27 vs 20.5 months, P = .028). Cleft type did not impact the proportion of patients with multiple tubes. Median age at last tube placement for children with multiple tubes was 5.0 years (range 1.9-8.7 years).
Conclusion:
Short duration of first tubes is associated with receiving multiple tubes. Because most patients require repeat tubes and many require tubes until school age, there is a significant need for controlled, prospective trials of early long-term tube placement in this population.