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Children with Cleft Palate: Predictors of Otologic Issues in the First 10 Years
Jamie L Funamura1, Janet W Lee1, Samantha McKinney1
11 Department of Otolaryngology-Head and Neck Surgery, UC Davis Health, Sacramento, California, USA.
Insights
Children with cleft palate often experience persistent ear problems, including tympanic membrane perforations and hearing loss, into their second decade of life. Continued otologic monitoring is crucial for these children beyond typical childhood development.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Anomalies
- Audiology
Background:
- Cleft palate is frequently associated with otologic complications.
- Eustachian tube dysfunction is a common sequela in children with cleft palate.
- Understanding the long-term otologic profile is essential for management.
Purpose of the Study:
- To characterize otologic issues in children with cleft palate up to age 10.
- To identify factors associated with persistent otologic problems.
- To inform long-term surveillance strategies.
Main Methods:
- Retrospective case series of 143 children with cleft palate.
- Chart review of otologic and audiologic outcomes.
- Statistical analysis including logistic regression.
Main Results:
- Persistent otologic issues such as tympanic membrane perforations (16.1%) and conductive hearing loss (23.1%) were common at age 10.
- History of palate revision surgery correlated with tympanic membrane perforations.
- Conductive hearing loss was linked to tympanic membrane perforations and genetic abnormalities.
Conclusions:
- A significant proportion of children with cleft palate face ongoing otologic challenges at age 10.
- Extended otologic monitoring is recommended for this population.
- Cleft severity did not predict long-term otologic outcomes.
Objective:
To evaluate the characteristics of children with cleft palate associated with persistent otologic issues in the first 10 years of life.
Study Design:
Case series with chart review.
Setting:
Single academic center.
Subjects And Methods:
Children born with cleft palate from 2003 to 2007 and treated by the UC Davis Cleft and Craniofacial Team between January 2003 and December 2017 were included in the study. Data from 143 patients were analyzed via Wilcoxon rank sum and Fisher exact tests for univariate analysis and logistic regression to determine adjusted odds ratios.
Results:
The median length of follow-up was 9.9 years, and the age at last ear examination was 10.7 years. At the last evaluation, unresolved otologic issues were common, with at least 1 ear having a tympanic membrane (TM) perforation (16.1%), a tympanostomy tube (36.2%), or conductive hearing loss (23.1%). After adjusting for demographic and clinical characteristics, history of palate revision or speech surgery was associated with having a TM perforation ( P = .02). The only clinical variables associated with conductive hearing loss was the presence of a TM perforation ( P < .01) or a genetic abnormality ( P = .02). Severity of palatal clefting was not associated with specific otologic or audiologic outcomes after adjusting for other characteristics.
Conclusion:
A large proportion of children with cleft palate have persistent otologic issues at age 10 years and would benefit from continued close monitoring well after the age when most children have normalized eustachian tube function. Prolonged otologic issues were not found to be associated with cleft type.
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