Comparison of audiometric outcomes between modified two-flap and Furlow's palatoplasty techniques: A retrospective...

Middle ear pathology and Eustachian tube dysfunction are commonly seen in patients with cleft lip and palate (CLP). Various palatoplasty techniques aim to improve velopharyngeal function, but their impact on middle ear recovery remains incompletely understood. The aim of this study was to compare the recovery of middle ear pathology between two primary palatoplasty techniques through audiometric evaluation. A retrospective cohort study of 211 CLP patients was conducted who underwent primary palatoplasty between January 2023 and December 2024 at a tertiary cleft center. Participants were divided into two groups based on the surgical technique received: Group 1 underwent Modified Two-flap palatoplasty with Intravelar veloplasty, while Group 2 underwent Modified Furlow's palatoplasty. The primary outcome was middle ear status assessed through standardized audiometric evaluation performed preoperatively and 6 months postoperatively. Chi-square test was used for categorical variables and independent t-tests was applied for continuous variables, with p < 0.05 considered significant. After propensity score matching, 76 matched pairs were analyzed with comparable baseline characteristics. Middle ear pathology recovery at 6 months was significantly higher in the Furlow's group (61.8%, 47/76) versus Bardachs group (23.7%, 18/76; p < 0.001). Type A tympanograms increased to 61.8% versus 15.8% respectively. Positive otoacoustic emissions improved to 56.6% versus 22.4% (p < 0.001). Multivariable analysis confirmed Furlow's superiority (OR 5.23, 95% CI 2.58-10.61, p < 0.001). Modified Furlow's palatoplasty demonstrated significantly better recovery of Eustachian tube function compared to Modified Two-flap palatoplasty with Intravelar veloplasty at 6 months post-surgery. This superior outcome is likely attributable to more radical transposition of the Tensor veli palatini muscle in the Furlow's technique, resulting in improved middle ear ventilation and better audiological outcomes in CLP patients.