Non-operative tympanic membrane perforation outcomes for cleft palate patients

Children with cleft palate (CP) have higher rates of eustachian tube dysfunction, leading to chronic otitis media, frequent tympanostomy tube (TT) placement, and ultimately tympanic membrane perforation (TMP), though the natural course of TMPs in this population has yet to be described.

An electronic medical record tool was used to identify patients with a diagnosis of CP and previous TT placement or TMP repair at a tertiary academic medical center. Patients with chronic TMP were identified by manual review. Qualities of the perforation, rate of resolution, and additional outcomes were analyzed. Chronic TMP was defined as a TM defect present on otoscopy at least 3 months apart, while TMP resolution was defined as an intact TM on any subsequent evaluation.

One hundred-six total ears were analyzed. Sixty-four (60 %) ears developed a chronic TMP, of which 43 (67 %) were observed without intervention. Twenty-one (49 %) observed TMPs resolved spontaneously, nearly half of which occurred within 1 year. No instances of cholesteatoma developed among healed perforations. TMP resolution occurred significantly more frequently if preceded by TT duration less than 2 years (13/16 = 81 % v. 6/18 = 33 %, p = 0.0138), but no significant effect was noted when controlling for age and location on logistic regression analysis. Time to resolution was significantly shorter with smaller TMP size when controlling for age and duration of TT intubation (OR = 1.23x10^-8; p = 0.041).

The presence of CP influences management decisions as the natural course of ear disease may be different. Perforations have the greatest chance to self-resolve within 1 year and may benefit most from operative closure thereafter. Knowledge of the rate of closure may be useful in TMP management strategies.