The inferiorly based pharyngoplasty: effects on chronic otitis media with effusion

Conflicting reports in the literature on the relationship between the inferiorly based pharyngeal flap and otitis media with effusion (OME) motivated a prospective study on 51 children between 3 and 12 years of age suffering from velopharyngeal incompetence. The patient group consisted of 34 children with cleft palate and 17 children with congenitally short palate. The male-female ratio was 37 to 14, showing no differences regarding physical disability. Each child underwent an inferiorly based pharyngoplasty. Repeated otoscopic, tympanometric, and audiometric examinations revealed that prior to pharyngoplasty half of the patients had bilateral chronic OME related to a conductive hearing loss of 30 to 35 dB. The disease was most frequently found in children with cleft palate (p less than 0.001) and in children less than 6 years of age (p less than 0.05). Bilateral chronic OME was independent of the type and side of cleft. Within 3 months of pharyngoplasty, a 60-percent decrease in the frequency of bilateral chronic OME was found. Children older than 6 years of age had most benefit with respect to OME (p less than 0.05). The biomechanical basis of the relationship between the pharyngeal flap and eustachian tube is discussed, focused on retropositioning of the levator muscle sling and reduced oronasal air leakage.