Impact of Palatoplasty on Middle-Ear Effusion in Children with Cleft Lip and Palate

Previous studies have primarily evaluated postoperative middle-ear outcomes following palatoplasty and ventilation tube insertion (VTI), with a focus on patient age and cleft severity. However, few have investigated the influence of cleft sidedness and variations in Furlow-based palatoplasty techniques. This study aimed to assess the presence of otitis media with effusion (OME) before and after palatoplasty, with or without VTI, and to identify factors associated with OME, including baseline patient characteristics, cleft sidedness, and surgical approach.

The authors retrospectively analyzed 86 children with cleft palate or cleft lip and palate who underwent palatoplasty at their hospital from October of 2017 to December of 2021, with at least 2 years of follow-up evaluating middle-ear outcomes.

Age at palatoplasty date, sex, congenital anomalies, and cleft severity were not significantly associated with preoperative OME. Complete clefts showed a higher OME incidence than incomplete cleft palate in univariable analysis, but not in multivariable analysis. The use rate of Furlow palatoplasty combined with hard palate repair increased with increasing cleft severity. Neither the choice of palatoplasty technique nor cleft sidedness was significantly associated with the presence of OME before palatoplasty or with the development of OME after palatoplasty. Postoperative OME rates were similar between children with OME undergoing VTI and those without OME treated by palatoplasty alone.

Cleft sidedness and surgical technique did not influence OME before or after palatoplasty. Ventilation tube insertion is beneficial for patients with OME but may be unnecessary in those without prior effusion.