Early Placement of Ventilation Tubes in Infants with Cleft Lip and Palate: A Systematic Review

2017 ◽  
Vol 158 (3) ◽  
pp. 459-464 ◽  
Author(s):  
Mark Felton ◽  
Jong Wook Lee ◽  
Darius D. Balumuka ◽  
Jugpal S. Arneja ◽  
Neil K. Chadha
Keyword(s):  
Middle Ear ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Data Sources ◽  
Tube Placement ◽  
Cochrane Central Register ◽  
Ventilation Tube ◽  
Tube Insertion ◽  
Ventilation Tubes ◽  
Palate Repair

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.

Should we aspirate middle-ear effusions prior to insertion of ventilation tubes?

2006 ◽  
Vol 120 (10) ◽  
pp. 818-821 ◽  
Author(s):  
V Laina ◽  
D D Pothier
Keyword(s):  
Middle Ear ◽  
Acoustic Trauma ◽  
Current Evidence ◽  
Cochrane Central Register ◽  
Ventilation Tube ◽  
Tube Insertion ◽  
Central Register ◽  
Increased Risk ◽  
Ventilation Tubes ◽  
Review Current

Background: Routine aspiration of middle-ear effusions prior to ventilation tube (grommet) insertion is practised by many surgeons. It has been suggested that removing the fluid from the middle ear improves immediate post-operative hearing levels and reduces the chance of the ventilation tube becoming obstructed. The potential adverse effects of applying suction to the middle ear include acoustic trauma and an increased risk of tympanosclerosis and otorrhoea. We undertook a review of the literature in order to determine the benefits or side effects associated with middle-ear aspiration prior to ventilation tube insertion.Objectives: To compare clinical outcomes associated with aspirating versus not aspirating the middle ear prior to ventilation tube insertion.Methods: The Cochrane ENT group trials register, DARE, the Cochrane central register of controlled trials (CENTRAL), MEDLINE (1960–2005) and EMBASE (1960–2005) were searched using relevant terms. Reference lists of selected studies were scanned for additional research material.Results: Seven studies were identified, of which three fitted the inclusion criteria of our review. Current evidence suggests that aspiration of middle-ear effusions prior to insertion of ventilation tubes is not associated with any improvement in clinical outcome, in terms of post-operative hearing levels, otorrhoea or rates of blockage of ventilation tubes. Significantly increased rates of tympanosclerosis were observed in one study and the development of acoustic trauma was observed; however, no significant association was confirmed. Although more research is needed, there is no evidence that aspiration of middle-ear effusion prior to grommet insertion confers any advantage.

Audiologic and Tympanometric Findings in Children with Cleft Lip and Palate

2003 ◽  
Vol 40 (3) ◽  
pp. 304-309 ◽  
Author(s):  
Gökhan Tunçbilek ◽  
Figen Özgür ◽  
Erol Belgin
Keyword(s):  
Cleft Palate ◽  
Middle Ear ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Tube Placement ◽  
Developmental Factors ◽  
Hearing Status ◽  
Ventilation Tubes ◽  
Middle Ear Disease ◽  
Simple Evaluation

Objective To evaluate the otologic and audiologic status of 50 children with repaired cleft lip, cleft palate, or both in Hacettepe University, Ankara, Turkey. Design Audiometric and tympanometric evaluation of 100 ears in 50 children were performed. Hearing levels ≤ 15 dB and middle ear pressures between −50 to +50 decaPascals were considered to be normal. Results were examined according to cleft type and laterality. The least and most affected frequencies were calculated. A simple evaluation of speech characteristics including nasal resonance, nasal air escape, and errors of articulation was also performed. Results Sixty-three of the 100 ears had normal hearing status, whereas 40 had normal middle ear pressures. No evidence was found to suggest that individual cleft type and laterality of the ear had any effect on hearing loss or middle ear disease. Two-thirds of the patients had normal or acceptable degree of language skills. Conclusion The final hearing status of patients with cleft palate is a result of a combination of surgical correction, developmental factors, and treatment of middle ear disease. Early and aggressive ventilation tube placement is the standard of cleft care in many countries. Our long-term hearing outcome is relatively good in a population not treated with routine insertion of ventilation tubes. The majority of patients also have satisfactory speech. Patients with cleft palate should have close follow-up for middle ear disease, but further research is warranted to determine the aggressive usage of ventilation tubes.

scholarly journals External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

2012 ◽  
Vol 69 (4) ◽  
pp. 363-366 ◽  
Author(s):  
Dragoslava Djeric ◽  
Milan Jovanovic ◽  
Ivan Baljosevic ◽  
Srbislav Blazic ◽  
Milanko Milojevic
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Membrane Surface ◽  
Tube Placement ◽  
External Ear ◽  
Ventilation Tube ◽  
Ear Canal ◽  
Tube Insertion ◽  
Tissue Mass ◽  
External Ear Canal

Introduction. Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC) developed following microsurgery (ventilation tube insertion and mastoidectomy), as well as to point ant possible mechanisms if its development. Case report. A 16-yearold boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT) findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT) insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease. Conclusion. There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone.

scholarly journals PREVALENCIA DE OTITIS MEDIA CON EFUSIÓN EN NIÑOS CON LABIO Y PALADAR HENDIDO.

2021 ◽  
Vol 31 (2) ◽  
pp. 27-32
Author(s):  
Karina Alvear Calero ◽  
Laura Cabezas Córdova ◽  
Diego Samaniego Andrade ◽  
Juan Carlos Vallejo Garzón
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Age Groups ◽  
Descriptive Study ◽  
Ventilation Tubes ◽  
Two Age Groups

IntroductionOtitis media with effusion (OME) is a highly prevalent problem in children with cleft lip and palate (CLP). The objective of this study was to establish the prevalence of OME in children with CLP younger than 1 year.Patients and methodsObservational and descriptive study in 19 patients younger than 1 year of age and of both genders, evaluated at the Hospital Metropolitano, from January 2017 to November 2019. The results of otoacoustic emissions and tympanometry were taken into account. The intraoperative presence of discharge in the middle ear established the certain diagnosis of OME.ResultsTwelve patients were men (63%) and 7 women (37%), 13 children (68%) were ≤6 months old, while 6 patients (32%) between 6 months and 1 year. All 19 cases were clinically diagnosed with OME, although the results of acoustic otoemissions and tympanometry were not always confirmed. At least 3 months old, they underwent myringotomy + placement of ventilation tubes. In the two age groups, all presented mucus in the middle ear confirming OME, the prevalence of cases of children under 6 months was 100%, 95% CI (77-100); in patients 6 months to 1 year it was also 100%, 95% CI (60-100).Conclusions The prevalence of OME in children younger than 1 year with CLP is 100%, a diagnosis established by the confirmed presence of a discharge in the middle ear

Comparison of the Hearing Histories of Children with and without Cleft Palate

1996 ◽  
Vol 33 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Patricia A. Broen ◽  
Karlind T. Moller ◽  
Jane Carlstrom ◽  
Shirley S. Doyle ◽  
Monica Devers ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Medical Records ◽  
Otitis Media With Effusion ◽  
Hearing Screening ◽  
Tube Placement ◽  
Ventilation Tube ◽  
Ventilation Tubes

Aggressive otologic management has been recommended for children with cleft palate because of the almost universal occurrence of otitis media with effusion (OME) in these children and the association of OME with hearing loss and possible language, cognitive, and academic delays. In this study, 28 children with cleft palate and 29 noncleft children were seen at 3-month intervals from 9 to 30 months to compare otologic treatment and management. Hearing and middle ear function were tested at each session; information on ventilation tube placement was obtained from medical records. Ventilation tubes were placed earlier and more often in children with cleft palate, but children with cleft palates failed the hearing screening more often. The correlation between age at first tube placement and frequency of hearing screening failures was significant for the children with cleft palate, indicating that the later tubes were first placed, the poorer the child's hearing.

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

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.

Middle ear findings and need for ventilation tubes among pediatric cleft lip and palate patients in northern Finland

2016 ◽  
Vol 44 (4) ◽  
pp. 460-464 ◽  
Author(s):  
Ville Lehtonen ◽  
Riitta H. Lithovius ◽  
Timo J. Autio ◽  
George K. Sándor ◽  
Leena P. Ylikontiola ◽  
...  
Keyword(s):  
Middle Ear ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Ventilation Tubes

Repair of Recurrent Cleft Palate with Free Vastus Lateralis Muscle Flap

2012 ◽  
Vol 49 (2) ◽  
pp. 245-248 ◽  
Author(s):  
Jose G. Christiano ◽  
Amir H. Dorafshar ◽  
Eduardo D. Rodriguez ◽  
Richard J. Redett
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Vastus Lateralis ◽  
Muscle Flap ◽  
Free Flaps ◽  
Vastus Lateralis Muscle ◽  
Oronasal Fistula ◽  
Lateralis Muscle ◽  
Palate Repair

A 6-year-old girl presented with a large recalcitrant oronasal fistula after bilateral cleft lip and palate repair and numerous secondary attempts at fistula closure. Incomplete palmar arches precluded a free radial forearm flap. A free vastus lateralis muscle flap was successfully transferred. No fistula recurrence was observed at 18 months. There was no perceived thigh weakness. The surgical scar healed inconspicuously. Free flaps should no longer be considered the last resort for treatment of recalcitrant fistulas after cleft palate repair. A free vastus lateralis muscle flap is an excellent alternative, and possibly a superior option, to other previously described free flaps.

Impact of cleft palate repair on speech and development of dentoalveolar deformities

2021 ◽  
Vol 16 (3) ◽  
pp. 47-53
Author(s):  
Yu.V. Stebeleva ◽  
◽  
Ad.A. Mamedov ◽  
Yu.O. Volkov ◽  
A.B. McLennan ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Normal Functioning ◽  
Primary Surgery ◽  
Cleft Palate Repair ◽  
Congenital Cleft ◽  
Palate Repair ◽  
Late Postoperative Period

Surgical repair of cleft palate is quite difficult because it aims not only to eliminate the anatomical defect of the palate, but also to ensure normal functioning, including speech. Moreover, successful surgery implies no or minimal deformation of the middle face that can be corrected in the late postoperative period. No doubt that primary surgery (both in terms of technique and time) is crucial for further growth and development of the maxilla. However, surgical techniques and the age of primary cleft palate repair vary between different clinics, which makes this literature review highly relevant. Key words: cleft palate repair, cleft palate, congenital cleft lip and palate

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