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Effect of Hamulotomy on Middle Ear Pressure and Eustachian Tube Dysfunction in Children With Cleft Palate: A
Suleka Ranganath1, Shibani Das1, Subrat Kumar Jena1
1Ashwini Trauma Centre, Cuttack, Orissa, India.
Insights
Hamulotomy, a procedure during cleft palate repair, does not significantly impact middle ear pressure or eustachian tube function. This suggests hamulotomy is safe for children undergoing palatoplasty, with minimal risk of ear dysfunction.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Hamulotomy is a surgical technique often used during palatoplasty in children with cleft palate.
- Eustachian tube dysfunction is a common complication impacting ear function and hearing in this population.
Purpose of the Study:
- To investigate the effects of hamulotomy on middle ear pressure and eustachian tube function in pediatric patients undergoing palatoplasty.
- To assess the safety and impact of hamulotomy on middle ear status.
Main Methods:
- A randomized study involving 24 children under 3 undergoing primary palatoplasty.
- Patients were divided into groups with and without hamulotomy.
- Impedance audiometry was used for pre- and post-operative assessment of middle ear pressure, volume, compliance, and eustachian tube function.
Main Results:
- No significant differences in middle ear status improvement or impedance audiometry results were observed between the hamulotomy and non-hamulotomy groups.
- Pre-existing middle ear pressure issues were noted in cleft children, with 58% showing type B tympanograms.
Conclusions:
- Hamulotomy does not appear to adversely affect middle ear pressure or eustachian tube function in children undergoing palatoplasty.
- Hamulotomy can be safely considered during palatoplasty due to its surgical benefits, without increasing the risk of middle ear dysfunction.
Abstract:
BackgroundHamulotomy is a surgical procedure primarily performed during palatoplasty procedure in cleft children. This study aims to explore the effects of hamulotomy on middle ear pressure and eustachian tube dysfunction, a critical factor in maintaining proper ear function and hearing.Material and MethodologyA total of 24 patients under the age of 3 were recruited for the study and underwent primary palatoplasty. Patients were assigned randomly to either have hamulotomy or not have hamulus fracture preoperatively. Middle ear pressure, ear canal volume, compliance, reflex, and eustachian tube function was assessed pre- and post-operatively in patients undergoing primary palatoplasty using impedance audiometry. Data were analyzed using the Wilcoxon signed rank test, McNemar's change test, and Mann-Whitney U test, with a significance level set at P ≤ 0.05.ResultsOtoscopy revealed that there was no significant difference in the improvement of middle ear status between the groups. Additionally, there was no significant difference in impedance audiometry results in either group. However, the test revealed that middle ear peak pressure in cleft children ranged from -324 to 375 dapa, and 58% of cleft children exhibited a type B tympanogram.ConclusionsHamulotomy does not appear to have a significant effect on middle ear pressure changes suggesting its safe use in palatoplasty without increasing the risk of middle ear dysfunction. Given the potential benefits of Hamulotomy in improving surgical access, tension free closure during palatoplasty, its use can be considered a viable option, with minimal concern for adverse effects on middle ear function.
