Success of tympanic membrane repair following palatoplasty

Eustachian tube dysfunction, ubiquitous in patients with cleft palate, is a known risk factor for failure of tympanic membrane (TM) repair. Age may also influence the success rate. We describe a cohort of patients with cleft palate who underwent TM repair at a tertiary academic medical center.

Record query of International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes for cleft palate and otologic procedures (myringoplasty, tympanoplasty, mastoidectomy, and/or ossicular chain reconstruction) was performed for patients treated between 1984 and 2017. Successful TM repair was defined as having an intact TM on otoscopy or a non-large volume tympanogram at most-recent follow-up.

Of 474 patients with a cleft palate, 25 (5%) underwent a TM repair, and 16 had complete records for analysis. Among these, there were 22 surgeries on 20 ears. Sixteen of 20 TM repairs were successful. The successful group underwent TM repair at a median age of 12.5 (range, 4.8 to 22.2) compared with a median age of 8.5 (range, 3.9 to 15.0) for the unsuccessful group (P=0.28). Patients whose TM repair was successful underwent TM repair a median of 9.1 years after palatoplasty (range, -1.2 to 21.2) compared with 7.2 years (range, 3.0 to 14.9) for the unsuccessful group (P=0.67).

In our cohort, TM repair in cleft palate patients had an 80% success rate. In contrast to conventional teaching, age at the time of surgery and time after palatoplasty may not affect TM repair outcomes.