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Timing of middle ear normalization after furlow palatoplasty vs. intravelar veloplasty
Tiffany Husman1, Patrick Barba2, Dylan K Chan2
1School of Medicine, University of California, San Francisco, USA.
Purpose:
To compare the impact of Furlow palatoplasty (FP) and intravelar veloplasty (IVVP) on time to middle ear normalization following cleft palate repair.
Methods:
A retrospective cohort study was conducted at a single tertiary care institution, including pediatric patients who underwent cleft palate repair between 2012 and 2024. Normal middle ear function was defined as type A tympanometry or a documented normal middle ear exam. Descriptive statistics, univariate and multivariate analyses, and time-to-event analyses were performed.
Results:
289 patients were analyzed, including 114 who underwent FP and 175 who underwent IVVP. Median age at repair was 10.0 months (IQR 10.0-12.0), and median follow-up duration was 30.0 months (IQR 13.0-53.0). Follow-up duration was significantly longer in the IVVP group (34.0 months [IQR 16.0-59.0]) compared to those who underwent FP (26.0 [IQR 11.0-43.0], p = 0.008). IVVP patients had a higher proportion of Veau III-IV clefts compared to FP (53.7% vs. 34.2%, p < 0.001). FP was associated with earlier middle-ear normalization on (HR 1.47, 95% CI 1.10-1.98, p = 0.010) and remained a significant predictor after adjusting for age, cleft severity, and the need for repeat tympanostomy tubes (HR 1.41 95% CI 1.02-1.94, p = 0.035). The median time to normalization was 31.0 months (IQR, 27-41) for FP versus 51.0 months (IQR, 42-58; p = 0.009) for IVVP.
Conclusion:
FP is associated with significantly earlier time to middle ear normalization when compared to IVVP, suggesting its potential benefit in reducing middle-ear disease.
