Ear Disease following Cleft Lip and Palate Surgery without Tympanostomy Tube Placement

Abstract

Objectives:

(1) Describe the current benefits and risks associated with perioperative prophylactic myringotomy during cleft lip/palate surgery. (2) Recognize potential predictive factors associated with middle ear disease following cleft lip/palate surgery. (3) Incorporate ethnic differences into treatment algorithms regarding tympanostomy tubes.

Methods:

A total of 241 children (129 Ecuadorian, 112 Chinese) underwent cleft lip/palate repair (2000-2009). Veau classification, age, history of ear infections, and cleft side were recorded. Average age was 2.4 years and 11.1 years for Ecuadorian and Chinese children, respectively. No patients underwent tympanostomy tube placement. Following surgical correction, serial otoacoustic emissions (OAE) testing, and tympanometry were performed, and a parental questionnaire was administered regarding behavioral hearing deficits and history of ear infections before and after surgery. Data were recorded and compared individually for the 2 populations and as a group to identify disease prevalence and correlative factors.

Results:

No association existed between Veau classification and deficits in tympanometry, OAE, or subjective hearing. Reported ear infections after surgery were fewer than before but were not significant (26% to 21%). Abnormal OAE testing was associated with abnormal tympanometry and subjective hearing deficits (P < .0001 and P = .004). Ecuadorian children had higher number of ear infections pre- and postoperatively (P = .043 and P < .001) and higher number of abnormal tympanograms (P = .003). No significant difference existed regarding OAE testing.

Conclusions:

Severity of the cleft lip/palate is not a predictive factor of middle ear disease and hearing impairment when no tympanostomy tube is placed. Ideal pressure equalization tube protocols should incorporate ethnic differences.