Exceptionally early tympanostomy tube placement in pediatric patients with cleft lip and palate

Objective Studies have shown that the majority of cleft lip and palate (CLP) children have middle ear fluid present at the time of lip repair (3-4 months). Despite hearing loss, the majority of children do not undergo ventilation tube treatment if required until the time of palate repair (9-12 months). We aimed to examine the effectiveness and potential complications of early ventilation tube placement prior to palatoplasty in infants with cleft lip and palate. Data Sources Medline (1946-2015), Embase (1980-2015), and EBM Reviews (Cochrane Central Register of Controlled). Review Methods Data sources were searched for publications that described the results of early ventilation tube placement in children with CLP prior to cleft palate repair. Two independent reviewers appraised the selected studies. Results Of 226 studies identified, 6 studies met the inclusion criteria. Early ventilation tube insertion in CLP gave similar speech and audiology outcomes to non-CLP children undergoing ventilation tube insertion and better outcomes than those children with CLP having later ventilation tube insertion at or after the time of palate closure. The main reported side effect was otorrhea, being higher for children with CLP having early ventilation tube insertion (67% vs 33%), with a reduction in otorrhea with increasing age. Larger studies with longer-term outcome reporting are required to fully address the study objectives. Conclusion Published data are limited but appear to support early insertion of ventilation tubes in children with CLP to restore middle ear function and maximize audiologic and speech outcomes.

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Epidemiology of Cleft Lip and Palate in Pediatric Patients

International Journal of Science and Research (IJSR) ◽

10.21275/v4i12.nov151805 ◽

2015 ◽

Vol 4 (12) ◽

pp. 273-275

Keyword(s):

Cleft Lip ◽

Pediatric Patients ◽

Cleft Lip And Palate

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Change in Initial Tympanostomy Tube Placement Timing Yields Decreased Burden of Care Without Increased Complications in Patients With Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620944759 ◽

2020 ◽

Vol 57 (12) ◽

pp. 1417-1421

Author(s):

William Davis ◽

Marilyn A. Cohen ◽

Martha S. Matthews

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Tube Placement ◽

Burden Of Care ◽

Hearing Thresholds ◽

Significant Difference ◽

Tympanostomy Tubes ◽

Newborn Hearing ◽

Palate Repair ◽

Practice Audit

Objective: To report a practice audit of the consequences of a change in protocol in the timing of placement of tympanostomy tubes in infants with cleft lip and palate. Participants: All children with a diagnosis of cleft lip and palate, treated between November 1998 and May 2006 under the old protocol, and between December 2012 and July 2016 under a new protocol. Under the old protocol, tympanostomy tubes were first inserted at the time of lip repair at around age 2 months. Under the new protocol, tympanostomy tubes were deferred until the time of palate repair around the age of 9 months. Children with syndromic diagnoses other than Stickler syndrome and Van der Woude syndrome, and children who failed newborn hearing screen were excluded. Main Outcome Measures: Incidence of otorrhea from birth to 6 months after palate repair and presence of hearing loss at ages 1 and 2. Results: Deferral of tympanostomy tubes until the time of palate repair decreases the burden of care due to otorrhea as compared to early tympanostomy tubes at the time of lip repair. There was no significant difference in the incidence of hearing thresholds at or below 15 dB at age 1 or 2. Conclusions: Placement of tympanostomy tubes at the time of palate repair balances the goals of minimizing the adverse effects from middle ear effusion and minimizing the burden of care on our patients and their families.

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Bimodal analgesia vs fentanyl in pediatric patients undergoing bilateral myringotomy and tympanostomy tube placement: a propensity matched cohort study

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2016.03.003 ◽

2016 ◽

Vol 32 ◽

pp. 162-168 ◽

Cited By ~ 3

Author(s):

Maxie L. Phillips ◽

Bryan C. Willis ◽

Aaron J. Broman ◽

Humphrey V. Lam ◽

Thanh T. Nguyen ◽

...

Keyword(s):

Cohort Study ◽

Pediatric Patients ◽

Tube Placement ◽

Matched Cohort ◽

Tympanostomy Tube ◽

Matched Cohort Study

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Otologic Disease Following Palatoplasty In International Cleft Palate Cohort

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617726998 ◽

2017 ◽

Vol 55 (2) ◽

pp. 162-167

Author(s):

Jeff Markey ◽

Rebecca Maine ◽

Kimberly Daniels ◽

Emily Yang Yu ◽

George Gregory ◽

...

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Country Of Origin ◽

Multivariable Analysis ◽

Otoacoustic Emission ◽

Patient Characteristics ◽

Tube Placement ◽

Type B

Objective: Study the prevalence of otologic disease in a pediatric post-palatoplasty population with no prior ear tube placement in resource-deprived countries and assess patient characteristics associated with these abnormal results. Design: Retrospective data review. Participants: Ecuadorian and Chinese children identified during humanitarian cleft lip and palate repair trips with cleft palates undergoing palatoplasty from 2007 to 2010. Interventions: Tympanometry and otoacoustic emission (OAE) testing performed following palatoplasty. Patients’ parents administered surveys regarding perceived hearing deficits. Main Outcome Measures: Age, gender, Veau classification, follow-up time, laterality, and country of origin were evaluated for possible association with type B tympanogram, “Refer” Otoacoustic results, and presence of hearing difficulty as identified by a parent. Significant predictors were further evaluated with multivariate analysis. Results: The cohorts included 237 patients (129 Ecuadorian, 108 Chinese); mean age: 3.9 years; mean follow-up: 4.2 years. Thirty-nine percent scored type B, 38% failed OAE testing, and 8% of parents noted hearing deficits. The country of origin and a younger age were identified as predictive variables regarding type B tympanogram. Follow-up time, country of origin, and bilateral OAE “Refer” results all significantly predicted parental questionnaire results. Subsequent multivariable analysis further demonstrated effect modification between the 2 variables of age at palatoplasty and country of origin when predicting type B vs type A tympanometry. Conclusion: Without otologic intervention, cleft palate children in resource-deprived settings suffer type B tympanometry and failed OAE results with similar to increased incidences to other studied cleft palate populations with otologic interventions available.

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Relationship of Velopharyngeal Insufficiency With Face Mask Therapy in Patients With Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619865155 ◽

2019 ◽

Vol 57 (1) ◽

pp. 118-122 ◽

Cited By ~ 1

Author(s):

Narmin Helal ◽

Matthew Ford ◽

Osama Basri ◽

Lindsay Schuster ◽

Brian Martin ◽

...

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Pediatric Patients ◽

Cleft Lip And Palate ◽

Face Mask ◽

The United States ◽

Velopharyngeal Insufficiency ◽

Patient Counseling ◽

Maxillary Protraction ◽

Increased Risk

Objective: To determine whether orthodontic/dentofacial orthopedic maxillary protraction face mask therapy induces changes in velopharyngeal functioning in a cohort of pediatric patients having cleft palate with or without cleft lip. Design: Retrospective chart review. Setting: A children’s hospital in the United States. Participants: Forty-three pediatric patients with cleft palate, with or without cleft lip, syndromic or with isolated clefts, who received face mask therapy from January 2009 to April 2016. Intervention: Clinical data were extracted for review and analysis from medical records obtained from the Cleft Database/Research Registry (CDB-RR). Main Outcome Measures: Pittsburgh Weighted Speech Scores (PWSS) before and after therapy. Results: There was a significant increase in PWSS after face mask therapy for patients with a PWSS score of 0 prior to treatment. Patients with PWSS >0 before treatment remained largely stable after face mask therapy. Maxillary advancement was not significantly associated with change in PWSS or fistula presence/absence. Conclusions: There is an increased risk of velopharyngeal insufficiency with maxillary protraction face mask treatment in patients with cleft palate. Patient counseling and obtaining consent regarding speech changes during treatment are recommended.

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Tympanostomy tube placement in awake, unrestrained pediatric patients: A prospective, multicenter study

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2015.11.003 ◽

2015 ◽

Vol 79 (12) ◽

pp. 2416-2423 ◽

Cited By ~ 9

Author(s):

Jacob W. Zeiders ◽

Charles A. Syms ◽

Mary T. Mitskavich ◽

David M. Yen ◽

Daniel T. Harfe ◽

...

Keyword(s):

Multicenter Study ◽

Pediatric Patients ◽

Tube Placement ◽

Tympanostomy Tube ◽

Prospective Multicenter Study

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Prevalence of nonsyndromic oral clefts in a reference hospital in the state of Minas Gerais, Brazil, between 2000-2005

Brazilian Oral Research ◽

10.1590/s1806-83242007000400006 ◽

2007 ◽

Vol 21 (4) ◽

pp. 314-317 ◽

Cited By ~ 36

Author(s):

Hercílio Martelli-Junior ◽

Letícia Vieto Porto ◽

Daniella Reis Barbosa Martelli ◽

Paulo Rogério Ferreti Bonan ◽

Amanda Beatriz Freitas ◽

...

Keyword(s):

Cleft Lip ◽

Pediatric Patients ◽

Cleft Lip And Palate ◽

Minas Gerais ◽

The State ◽

Craniofacial Anomalies ◽

Oral Clefts ◽

Reference Hospital ◽

Isolated Cleft Palate ◽

Male To Female

The aim of the present study was to analyze the prevalence of nonsyndromic oral clefts in children receiving treatment at the Center for the Rehabilitation of Craniofacial Anomalies, José do Rosário Vellano University, Alfenas, MG, Brazil. All the data for the epidemiological study was retrieved from the files of 126 pediatric patients with oral clefts without any additional malformation, who came to the center for treatment between 2000 and 2005. A predominance of clefts was observed in Caucasians, and the ratio of male to female was 1.3. Males were 2.57 times more affected by cleft lip and palate (CLP) than females. CLP with a prevalence of 39.68% and isolated cleft lip (CL) with a prevalence of 38.09% were the most common anomalies, followed by isolated cleft palate (CP; 22.23%). Complete and unilateral CLP (26.19%) presented the highest prevalence, followed by incomplete and unilateral CL (23.81%). The present study presents the experience of a reference hospital in the state of Minas Gerais; however, the real prevalence of oral clefts in Brazil is still unknown. Our findings differ from those of a few previous Brazilian reports because they suggest similar prevalences of CLP and CL, and a higher prevalence of CLP in Caucasian males.

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