Formula Otorrhea in Pediatric Patients With Cleft Palate

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Gastroenterology

Background:

• Cleft lip and palate (CLP) is associated with feeding difficulties and an increased risk of middle ear infections.
• Chronic otitis media with effusion (OME) is common in infants and often treated with pressure-equalizing (PE) tubes.
• Formula otorrhea, discharge from the ear containing formula, is an uncommon complication.

Purpose of the Study:

• To describe two unusual cases of male newborns with CLP who developed formula otorrhea post-PE tube insertion.
• To investigate the link between formula reflux and otorrhea in infants with CLP.
• To emphasize the importance of considering formula reflux in the differential diagnosis of otorrhea in this patient population.

Main Methods:

• Case series detailing two male newborns with CLP.
• Patients underwent bilateral myringotomies with PE tube insertion for chronic OME.
• Otorrhea was assessed, and treatment included antibiotic ear drops, ear cleaning, anti-reflux medication, and reflux precautions.
• Outcome was evaluated after cleft palate repair.

Main Results:

• Both patients developed chronic otorrhea associated with feeding after PE tube placement.
• Otorrhea was confirmed to be due to formula reflux into the middle ear.
• Treatment with conservative measures and reflux precautions led to resolution of otorrhea.
• Complete resolution of formula otorrhea occurred after cleft palate repair.

Conclusions:

• Formula reflux into the middle ear is a potential cause of chronic otorrhea in infants with CLP following PE tube insertion.
• Early recognition and management of formula reflux, including conservative treatment and surgical repair of CLP, are crucial.
• This case series underscores the need for vigilance in diagnosing and treating otorrhea in infants with CLP, considering formula reflux as a contributing factor.