Balancing intervention and complications: management of otitis media with effusion in children with cleft palate
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Burçay Tellioğlu1, Erim Pamuk1, Muhammed Çağrı Külekci1
1Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye.
Insights
Preoperative hearing loss severity predicts the need for ventilation tubes (VT) in children with cleft palate (CP). Mild to moderate hearing loss increases the likelihood of VT insertion, guiding individualized treatment decisions.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Audiology
Background:
- Children with cleft palate (CP) face high risks of otitis media with effusion (OME), potentially impacting hearing, speech, and development.
- Ventilation tube (VT) insertion during palatoplasty is common but its routine use is debated due to uncertain benefits and risks.
Purpose of the Study:
- Identify preoperative audiological predictors for VT necessity in CP patients.
- Evaluate VT-related complications in this population.
Main Methods:
- Retrospective review of 65 non-syndromic CP patients undergoing palatal repair without prior VT.
- Analysis of preoperative hearing thresholds, cleft severity (Veau classification), and postoperative VT insertion/complications.
Main Results:
- VT insertion likelihood significantly increased with preoperative hearing loss severity (5.9% normal hearing to 75% moderate CHL).
- Mild to moderate conductive hearing loss (CHL) showed significant differences compared to normal hearing (p < 0.001).
- Higher cleft severity correlated with increased VT placement (Veau I: 10%, Veau IV: 69.2%), but not with preoperative hearing or complications.
Conclusions:
- Preoperative hearing level is a strong predictor of VT need in CP patients.
- Mild to moderate CHL warrants early intervention, while normal hearing may benefit from a conservative approach.
- Individualized, hearing-based decisions for VT placement are recommended over routine use.
Background:
Children with cleft palate (CP) are at high risk for otitis media with effusion (OME), which may impair hearing, speech, and development. Although ventilation tube (VT) insertion during palatoplasty is common, its universal use is debated due to uncertain long-term benefits and potential complications. This study aimed to identify preoperative audiological predictors of VT necessity and evaluate VT-related complications.
Methods:
A retrospective review was conducted on 65 non-syndromic CP patients who underwent palatal repair without prior or concurrent VT placement. Preoperative audiological evaluations were performed, and patients were followed postoperatively for VT insertion and complications. Preoperative hearing thresholds, cleft severity (Veau classification), and VT related complications were analyzed statistically.
Results:
The likelihood of VT insertion rose significantly in parallel with the severity of preoperative hearing loss, ranging from just 5.9% in patients with normal hearing to 75% in those with moderate conductive hearing loss (CHL) (p < 0.001). Pairwise comparisons showed significant differences between normal hearing and both mild (p = 0.0026) and moderate CHL (p = 0.01). CP severity was not associated with preoperative hearing but correlated with higher VT placement (Veau I: 10%, Veau IV: 69.2%; p = 0.035). Complications included otorrhea (45.2%), early extrusion (35.5%), and tympanic membrane perforation (12.9%), with no significant associations to preoperative hearing level and CP severity.
Conclusion:
Preoperative hearing level at the time of palate repair is a strong predictor of VT need in CP patients. Mild to moderate CHL significantly increases the risk of persistent OME, supporting early intervention. Normal or slight loss often resolves without treatment, favoring a conservative approach. Higher cleft severity is associated with increased VT placement rates; it does not correlate with preoperative hearing levels or increased VT-related complications. These findings highlight the value of individualized, hearing-based decisions over routine tube placement.
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