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Exceptionally early tympanostomy tube placement in pediatric patients with cleft lip and palate
Jeffrey Koempel1, Beth Osterbauer1, Ido Badash2
1Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd. Mailstop #48, Los Angeles, CA, 90027, USA.
Insights
Placing tympanostomy tubes (TT) concurrently with cleft lip repair in infants under 8 weeks is feasible. While no major complications arose, a high rate of otorrhea was observed, necessitating further research.
Area of Science:
- Pediatric Otolaryngology
- Craniofacial Surgery
- Audiology
Background:
- Cleft lip repair is typically performed by 8 weeks of age.
- Concurrent tympanostomy tube (TT) placement is sometimes performed in these infants.
- The feasibility of this early intervention requires investigation.
Purpose of the Study:
- To assess the feasibility of tympanostomy tube (TT) placement in infants younger than 8 weeks.
- To present preliminary results regarding complications and audiological outcomes.
- To evaluate the safety and efficacy of early TT insertion during cleft lip repair.
Main Methods:
- Retrospective review of 22 infants with cleft lip/palate undergoing TT placement within 8 weeks of birth.
- Data collection focused on complications and audiologic function post-procedure.
- Audiologic evaluations were performed to assess hearing outcomes.
Main Results:
- Mean age at TT placement and cleft lip repair was 3.9 weeks.
- Otorrhea occurred in 59% of patients during follow-up.
- 86% of patients demonstrated normal audiological function post-TT placement; some experienced hearing loss due to tube extrusion or otitis media with effusion (OME).
Conclusions:
- Exceptionally early tympanostomy tube (TT) placement is feasible.
- While major complications were absent, otorrhea was common.
- Further randomized, prospective studies are needed to confirm benefits and optimize timing.
Objective:
At our institution, cleft lip repair is performed at or before 8 weeks of age, and tympanostomy tubes (TT) have been inserted concurrently in some of these patients. Our objective was to determine the feasibility and present the preliminary results of TT placement at this early age.
Methods:
A retrospective review was conducted of 22 patients born with cleft lip and/or palate who had TT placement in the first 8 weeks of life. Data collected included complications and audiologic function post TT placement.
Results:
Subjects had a mean age of 3.9 weeks at the time of TT placement and cleft lip repair. Thirteen patients (59%) reported otorrhea during the follow-up period. Eighteen of 21 (86%) patients who underwent auditory evaluation had normal audiological function following TT placement. One patient had sensorineural hearing loss and 2 patients had mild conductive hearing loss due to bilateral extruded TT and OME at 15.9 and 39.2 months after surgery.
Conclusion:
Exceptionally early TT is feasible. Placing TT at or before 8 weeks of age did not result in any major complications but demonstrated a high incidence of otorrhea. A randomized, prospective study with a larger sample size is necessary to determine the benefits of TT placement at this age.
