To investigate hearing thresholds in children born with cleft palate and in children with otitis media with effusion but no cleft palate.
Design:
Prospective longitudinal group comparison study.
Setting:
University hospital.
Participants:
Sixteen children born with nonsyndromic cleft palate with or without cleft lip (CP±L) and 15 age-matched children with otitis media with effusion (OME) but without cleft.
Main Outcome Measures:
Hearing was tested at repeated occasions beginning with neonatal auditory brainstem response (ABR) at 1-4 months of age, and age-appropriate hearing tests from 9 to 36 months of age.
Results:
The median ABR thresholds in both groups were elevated but did not differ significantly. At 12 months of age, the median 4 frequency averages at 500-1000-2000-4000 Hz (4FA) were indicative of mild hearing loss but significantly better in the CP±L-group than in the group without cleft (P < .01). There were no significant group-wise differences regarding the median 4FA at 24 and 36 months of age, and at 36 months, the median 4FA were normal in both groups. Both groups exhibited a significant improvement over time from the neonatal ABR thresholds to the 4FA at 36 months (CP±L-group P < .05; without CP±L-group P < .01).
Conclusion:
The hearing loss in children with CP±L was not more severe than among children with OME but without cleft palate; rather, at 12 months of age, the thresholds were significantly better in the CP±L-group than those in the group without cleft. The air conduction thresholds improved with age in both groups.
AlperCMLoseeJEMandelEMSerokyJTSwartsJDDoyleWJ. Pre- and post-palatoplasty Eustachian tube function in infants with cleft palate. Int J Pediatr Otorhinolaryngol. 2012;76(3):388–391. doi:10.1016/j.ijporl.2011.12.017.
2.
BluestoneCD. Pathogenesis of otitis media: role of Eustachian tube. Pediatr Infect Dis J. 1996;15(4):281–291.
3.
BluestoneCDHebdaPAAlperCMSandoIBuchmanCAStangerupSEFeldingJUSwartsJDGhadialiSNTakahashiH. Recent advances in otitis media. 2. Eustachian tube, middle ear, and mastoid anatomy; physiology, pathophysiology, and pathogenesis. Ann Otol Rhinol Laryngol Suppl. 2005;194:16–30.
4.
BroenPADeversMCDoyleSSProutyJMMollerKT. Acquisition of linguistic and cognitive skills by children with cleft palate. J Speech Lang Hear Res. 1998;41(3):676–687.
5.
BroenPAMollerKTCarlstromJDoyleSSDeversMKeenanKM. Comparison of the hearing histories of children with and without cleft palate. Cleft Palate Craniofac J. 1996;33(2):
127–133. doi:10.1597/1545-1569(1996)033<0127: cothho>2.3.co;2.
6.
FlynnTLohmanderAMollerCMagnussonL. A longitudinal study of hearing and middle ear status in adolescents with cleft lip and palate. Laryngoscope. 2013;123(6):1374–1380. doi:10.1002/lary.23839.
7.
FlynnTMollerCJonssonRLohmanderA. The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts. Int J Pediatr Otorhinolaryngol. 2009;73(10):1441–1446. doi:10.1016/j.ijporl.2009.07.015.
8.
GrantHRQuineyREMercerDMLodgeS. Cleft palate and glue ear. Arch Dis Child. 1988;63(2):176–179.
9.
GravelJSRobertsJERoushJGroseJBesingJBurchinalMNeebeEWallaceIFZeiselS. Early otitis media with effusion, hearing loss, and auditory processes at school age. Ear Hear. 2006;27(4):353–368. doi:10.1097/01.aud.0000224727.45342.e9.
10.
GravelJSWallaceIFRubenRJ.Auditory consequences of early mild hearing loss associated with otitis media. Acta Otolaryngol. 1996;116(2):219–221
11.
HallJWGroseJH. The effect of otitis media with effusion on the masking-level difference and the auditory brainstem response. J Speech Hear Res. 1993;36(1):210–217.
12.
HellströmSGrothAJorgensenFPetterssonARydingMUhlenIBostromKB. Ventilation tube treatment: a systematic review of the literature. Otolaryngol Head Neck Surg. 2011;145(3):383–395. doi:10.1177/0194599811409862.
13.
JohnsonDLMcCormickDPBaldwinCD. Early middle ear effusion and language at age seven. J Commun Disord. 2008;41(1):20–32. doi:10.1016/j.jcomdis.2007.03.001.
14.
KaranthTKWhittemoreKR. Middle-ear disease in children with cleft palate. Auris Nasus Larynx. 2018;45(6):1143–1151. doi:10.1016/j.anl.2018.04.012.
15.
KuoCLTsaoYHChengHMLienCFHsuCHHuangCYShiaoAS. Grommets for otitis media with effusion in children with cleft palate: a systematic review. Pediatrics. 2014;134(5):983–994. doi:10.1542/peds.2014-0323.
16.
KuscuOGunaydinROIcenMErgunOKulak KayikciMEYilmazTOzgurFFAkyolMU. The effect of early routine grommet insertion on management of otitis media with effusion in children with cleft palate. J Craniomaxillofac Surg. 2015;43(10):2112–2115. doi:10.1016/j.jcms.2015.09.008.
17.
KwanWMAbdullahVJLiuKvan HasseltCATongMC. Otitis media with effusion and hearing loss in Chinese children with cleft lip and palate. Cleft Palate Craniofac J. 2011;48(6):684–689. doi:10.1597/10-006.
18.
LidenG. The scope and application of current audiometric tests. J Laryngol Otol. 1969;83(6):507–520.
19.
LohmanderA.Speech and language development in children born with cleft palate and possible impact of OME. Paper presented at: The 7th Extraordinary International Symposium on Recent Advances in Otitis Media; 2013; Stockholm, Sweden.
20.
LohmanderAOlssonMFlynnT. Early consonant production in Swedish infants with and without unilateral cleft lip and palate and two-stage palatal repair. Cleft Palate Craniofac J. 2011;48(3):271–285. doi:10.1597/09-105.
21.
MargolisRHSalyGLHunterLL. High-frequency hearing loss and wideband middle ear impedance in children with otitis media histories. Ear Hear. 2000;21(3):206–211.
22.
MartiniMStephensR. Definitions, Protocols & Guidelines in Hearing Impairment. London England, Philadelphia: Whurr Publishers Ltd; 2001.
23.
ParadiseJLDollaghanCACampbellTFFeldmanHMBernardBSColbornDKRocketteHEJanoskyJEPitcairnDLKurs-LaskyM, et al.Otitis media and tympanostomy tube insertion during the first three years of life: developmental outcomes at the age of four years. Pediatrics. 2003;112(2):265–277.
24.
ParadiseJLDollaghanCACampbellTFFeldmanHMBernardBSColbornDKRocketteHEJanoskyJEPitcairnDLSaboDL, et al.Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life. Pediatrics. 2000;105(5):1119–1130.
25.
ParadiseJLFeldmanHMCampbellTFDollaghanCARocketteHEPitcairnDLSmithCGColbornDKBernardBSKurs-LaskyM, et al.Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356(3):248–261. doi:10.1056/NEJMoa062980.
26.
PhuaYSSalkeldLJDe ChalainTM. Middle ear disease in children with cleft palate: protocols for management. Int J Pediatr Otorhinolaryngol. 2009;73(2):307–313. doi:10.1016/j.ijporl.2008.10.026.
27.
PonduriSBradleyREllisPEBrookesSTSandyJRNessAR. The management of otitis media with early routine insertion of grommets in children with cleft palate—a systematic review. Cleft Palate Craniofac J. 2009;46(1):30–38. doi:10.1597/07-219.1.
28.
RobertsJHunterLGravelJRosenfeldRBermanSHaggardMWallaceI. Otitis media, hearing loss, and language learning: controversies and current research. J Dev Behav Pediatr. 2004;25(2):110–122.
29.
RobertsJERosenfeldRMZeiselSA. Otitis media and speech and language: a meta-analysis of prospective studies. Pediatrics. 2004;113(3 pt 1):e238–e248.
30.
RydingMKonradssonKWhitePKalmO. Hearing loss after “refractory” secretory otitis media. Acta Otolaryngol. 2005;125(3):250–255.
31.
SchilderAGSnikAFStraatmanHVan den BroekP. The effect of otitis media with effusion at preschool age on some aspects of auditory perception at school age. Ear Hear. 1994;15(3):224–231.
32.
SellDSouthbyLWrenYWillsAKHallAMahmoudONessAR. Centre-level variation in speech outcome and interventions, and factors associated with poor speech outcomes in 5-year-old children with non-syndromic unilateral cleft lip and palate: The Cleft Care UK Study. Part 4. Orthod Craniofac Res. 2017;20(suppl 2):27–39. doi:10.1111/ocr.12186.
33.
ShafferADFordMDChoiSSJabbourN. The impact of timing of tympanostomy tube placement on sequelae in children with cleft palate. Cleft Palate Craniofac J. 2019;56(6):720–728. doi:10.1177/1055665618809228.
34.
ShawWSembGLohmanderAPerssonCWilladsenEClayton-SmithJTrindadeIKMunroKJGambleCHarmanNH, et al.Timing of primary surgery for cleft palate (TOPS): protocol for a randomised trial of palate surgery at 6 months versus 12 months of age. Br Med J Open. 2019;9(7):e029780. doi:10.1136/bmjopen-2019-029780.
35.
ShribergLDFriel-PattiSFlipsenPJrBrownRL. Otitis media, fluctuant hearing loss, and speech-language outcomes: a preliminary structural equation model. J Speech Lang Hear Res. 2000;43(1):100–120.
36.
SmillieIRobertsonSYuleAWynneDMRussellCJ. Complications of ventilation tube insertion in children with and without cleft palate: a nested case–control comparison. JAMA Otolaryngol Head Neck Surg. 2014;140(10):940–943. doi:10.1001/jamaoto.2014.1657.
37.
SmithTLDiRuggieroDCJonesKR. Recovery of Eustachian tube function and hearing outcome in patients with cleft palate. Otolaryngol Head Neck Surg. 1994;111(4):423–429.
38.
SundmanHFlynnTTengrothBLohmanderA. ABR thresholds in infants born with CLP and OME and infants with OME. Int J Pediatr Otorhinolaryngol. 2016;81:21–25. doi:10.1016/j.ijporl.2015.11.036.
39.
TasakaYKawanoMHonjoI.Eustachian tube function in OME patients with cleft palate. Special reference to the prognosis of otitis media with effusion. Acta Otolaryngol Suppl. 1990;471:5–8.
40.
TengrothBHederstiernaCNeoviusEFlynnT. Hearing thresholds and ventilation tube treatment in children with unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol. 2017;97:102–108. doi:10.1016/j.ijporl.2017.03.031.
41.
ToddNWJr. Otitis media and Eustachian tube caliber. Acta Otolaryngol Suppl. 1983;404:1–17.
42.
YangFFMcPhersonBShuH. Evaluation of an auditory assessment protocol for Chinese infants with nonsyndromic cleft lip and/or palate. Cleft Palate Craniofac J. 2012;49(5):566–573. doi:10.1597/09-140.1.
43.
ZumachAChenaultMNAnteunisLJGerritsE. Speech perception after early-life otitis media with fluctuating hearing loss. Audiol Neurootol. 2011;16(5):304–314. doi:10.1159/000322501.
44.
ZumachAGerritsEChenaultMAnteunisL. Long-term effects of early-life otitis media on language development. J Speech Lang Hear Res. 2010;53(1):34–43. doi:10.1044/1092-4388(2009/08-0250).
