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Relevance of cleft palatal width in short-term otologic outcomes
H L Martin1, E R Poehlein2, A C Allori3
1Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, 40 Duke Medicine Circle, DUMC 3805, 27710, Durham, NC, USA.
Insights
Children with wider cleft palate face increased risks of Eustachian tube dysfunction (ETD) and middle ear issues. Cleft width is a key factor in predicting the severity of ETD and guiding treatment decisions.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Genetics
Background:
- Children with cleft palate have a higher risk of Eustachian tube dysfunction (ETD) and conductive hearing loss.
- The relationship between cleft palate width and ETD severity requires further investigation.
- Understanding this link can inform prognoses and treatment strategies for tympanostomy tube placement.
Purpose of the Study:
- To evaluate the severity of ETD in children with narrow, moderate, and wide cleft palates.
- To examine hearing outcomes, tympanostomy procedures, and otologic complications based on cleft width.
- To determine if cleft width has prognostic value for middle ear dysfunction.
Main Methods:
- Retrospective chart review of 58 patients undergoing primary palatoplasty.
- Comparison of otologic procedures, audiometric findings, and complications across cleft width groups (<10 mm, 10-15 mm, >15 mm).
- Analysis considered palatal morphology, syndromes, and otitis media risk factors.
Main Results:
- Patients with moderate and wide cleft palates required more otologic procedures on average.
- Wider clefts were associated with lower rates of normal hearing after the first tympanostomy.
- A shorter interval between first and second tympanostomy procedures was observed in patients with wide cleft palates.
Conclusions:
- Wider cleft palates appear to correlate with increased susceptibility to severe ETD.
- Cleft width is a potential prognostic indicator for persistent middle ear dysfunction.
- Further research can support personalized clinical decision-making for cleft palate management.
Objective:
Children with cleft palate are at increased risk for Eustachian tube dysfunction (ETD) and conductive hearing loss from chronic otitis media. While it has been proposed that the severity of ETD is related to the severity of cleft palate, data are lacking to support this hypothesis. An improved understanding of the relevance of cleft width may have prognostic value that could inform decisions on the timing of tympanostomy tube placement and choice of tympanostomy tube design. The objective of this study was to assess severity of ETD in children with narrow, moderate, and wide cleft palate, with examination of hearing outcomes, number of tympanostomy procedures, and incidence of otologic complications.
Methods:
Retrospective chart review was conducted on 58 patients with primary palatoplasty performed at a single academic medical center from January 1, 2016-December 31, 2019. The primary outcome was the number of otologic procedures performed after the initial palatoplasty. Secondary outcomes included audiometric findings, number of tympanostomy tube placements, presence of effusion at the time of myringotomy, and occurrence of any postoperative otologic complication. Outcomes were compared for patients with narrow (<10 mm), moderate (10-15 mm), and wide (>15 mm) cleft palate. Analysis included consideration of cleft palatal morphology (Veau I - IV), presence of Robin sequence or syndromes, and risk factors for otitis media.
Results:
Patients with moderate and wide cleft palate underwent higher mean numbers of otologic procedures [narrow: 1.3 (95% confidence interval [CI] 0.9, 1.7); moderate: 1.6 (95% CI 1.1, 2.1); wide: 1.8 (95% CI 1.2, 2.4)]. Moderate and wide cleft palate were less likely to have normal hearing after their first tympanostomy (narrow: 50%, 10/20; moderate: 25%, 6/24; wide: 36%, 5/14). Patients with a wide cleft palate had a shorter median time between first and second tympanostomy procedures (median, IQR; narrow: 27.0, 20.8-35.7; moderate 20.4, 16.3-25.9; wide 17.3, 11.5-23.4).
Conclusion:
Our findings suggest that patients with wider cleft palate may be more susceptible to severe ETD. Further large-scale study may help to allow for more informed and personalized clinical decision making for management of cleft palate, incorporating cleft width for prognosis of risks for persistent middle ear dysfunction.
