scholarly journals The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

2015 ◽  
Vol 19 (68) ◽  
pp. 1-374 ◽  
Author(s):  
Iain Bruce ◽  
Nicola Harman ◽  
Paula Williamson ◽  
Stephanie Tierney ◽  
Peter Callery ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Cleft Palate ◽  
Otitis Media ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Otitis Media With Effusion ◽  
Recruitment Rate ◽  
Future Research ◽  
Economic Modelling ◽  
The Uk

BackgroundCleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate.ObjectivesTo identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies.DesignThe management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP.SettingThe survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients’ homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting.ParticipantsClinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association.ResultsThe clinician survey revealed that care was predominantly delivered via a ‘hub-and-spoke’ model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research.ConclusionsThere exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered.FundingThe National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.

Evaluating the Frequency of Ear Problems in Patients with Cleft Lip and Palate

2021 ◽  
Author(s):  
Fatemeh Mirashrafi ◽  
Babak Saedi ◽  
Mahtab Rabbani Anari ◽  
Gholamreza Garmaroudi ◽  
Roja Toosi ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cleft Palate ◽  
Otitis Media ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Conductive Hearing Loss ◽  
Otitis Media With Effusion ◽  
Pure Tone Audiometry ◽  
Hearing Disorders ◽  
Conductive Hearing

Background: Orofacial cleft is one of the most common congenital malformations of craniofacial region. Otitis media with effusion causing conductive hearing loss is a considerable challenge for many children with cleft lip and palate. The aim of this study was to evaluate the prevalence of hearing disorders and associated malformations in these patients. Methods: The research population consisted of patients with cleft palate, between years 2012 and 2014, who were referred to Children’s Medical Center and Vali-e-Asr hospital in Tehran, Iran. Otoscopic examination, tympanometry, pure tone audiometry and echocardiography were performed for each patient. Results: Among patients with cleft palate, 73% suffered from hearing disorders. There was no relationship between prevalence of hearing loss and sex, presence of other congenital anomalies and degree of cleft, but middle ear diseases were significantly higher in children younger than 2 years. Among patients with cleft lip or palate, 10% suffered from cleft lip, 63% suffered from cleft palate and 27% suffered from cleft lip and palate. There was at least one congenital anomaly in 53% of patients. Conclusion: This study demonstrates high prevalence of otitis media with effusion and conductive hearing loss in patients with cleft. However, audiologic problems are alleviated when patients become older.

scholarly journals Kajian faktor-faktor yang berhubungan dengan skor nasalance pada pasien celah palatum

2016 ◽  
Vol 45 (2) ◽  
pp. 131
Author(s):  
Duhita Yassi ◽  
Dini Widiarni ◽  
Tri Juda Airlangga ◽  
Lestaria Aryanti ◽  
Muchtarudin Mansyur
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Otitis Media With Effusion ◽  
Group Analysis ◽  
Cross Sectional ◽  
Purposive Sampling ◽  
Significant Difference ◽  
The Mean

Latar belakang: Celah bibir dan palatum merupakan kelainan proses pertumbuhan area orofasial yang menimbulkan permasalahan kompleks. Penelitian ini menitikberatkan permasalahanyang terkait dengan fungsi bicara. Tujuan: Penelitian ini melaporkan gambaran skor nasalance padacelah palatum, hubungan antara skor nasalance percontoh celah palatum dan tanpa celah palatum sertafaktor-faktor yang berhubungan dengan skor nasalance. Metode: Desain penelitian adalah comparativecross sectional. Pengambilan percontoh dilakukan dengan purposive sampling. Dilakukan wawancara,pengisian kuesioner, pemeriksaan THT, audiometri, timpanometri, nasoendoskopi, dan nasometri.Hasil: Didapatkan gambaran rerata skor nasalance percontoh celah palatum. Terdapat  perbedaanbermakna antara skor nasalance percontoh celah palatum dan tanpa celah palatum pada Uji Gajah danUji Hantu (p<0,001). Pada analisis multivariat secara keseluruhan faktor-faktor yang berhubungandengan skor nasalance (adenoid, otitis media efusi, serta gangguan pendengaran) dan keberadaancelah palatum berpengaruh secara signifikan terhadap skor nasalance untuk semua uji nasalance(p<0,05) pada pengujian terhadap kedua kelompok percontoh. Bila dilihat secara parsial faktor adenoidberpengaruh secara signifikan terhadap skor semua uji nasalance baik pada analisis kedua kelompokpercontoh maupun pada percontoh celah palatum saja. Kesimpulan: Rerata skor nasalance kelompokcelah palatum lebih tinggi daripada kelompok tanpa celah palatum. Didapatkan peran faktor yangberpengaruh terhadap skor nasalance, khususnya adenoid. Diperlukan penelitian lebih lanjut terhadappercontoh sesudah operasi sehingga bisa dijadikan sebagai evaluasi terhadap keberhasilan tindakan. Kata kunci: celah palatum, skor nasalance, tonsil, adenoid, otitis media efusi, gangguan pendengaran ABSTRACTBackground: Cleft lip and palate is an orofacial malformation and associated with many problems. This study concerned in speech problem in cleft palate patients. Purpose: This study reportednasalance score in cleft palate patients, the correlation between nasalance score in cleft palate and noncleft palate groups and also some factors related with nasalance score in cleft palate patients. Methods:The design of this study was comparative cross sectional, with purposive sampling. Data was collectedwith interview, questioner apllication, ENT examination, audiometry, tympanometry, nasoendoscopy,and nasometry. Results: The result of this study reported the mean of nasalance score in cleft palatepatients. There was significant difference in nasalance score between cleft palate and non cleft palatepatients in Uji Gajah and Uji Hantu (p>0,05). In multivariate analysis, in general the factors relatedwith nasalance score (adenoid, otitis media with effusion, and hearing loss) and cleft palate  itself weresignificantly correlated with nasalance score in all nasalance test (p<0,05) in both groups analysis butno signifficant correlation in cleft palate group analysis. Partially, adenoid  was significantly correlated in both group analysis and cleft palate group analysis. Conclusion: The mean of nasalance score incleft palate group was higher than non cleft group. Some factors in this study, especially adenoid had corelations with nasalance score. It needs further study to evaluate the nasalance score patients withcleft palate after surgery to compare the results. Keywords: cleft palate, nasalance score, tonsil, adenoid, otitis media with effusion, hearing disturbance

Alveolar Backing in 3-Year-Old Children With and Without Repaired Cleft Palate: Preliminary Findings Related to Cleft Type and History of Otitis Media

2021 ◽  
pp. 1-11
Author(s):  
David J. Zajac ◽  
Hannah Whitt ◽  
Adriane Baylis ◽  
Maura Tourian ◽  
Katie Garcia
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Otitis Media With Effusion ◽  
Spectral Difference ◽  
Exact Test ◽  
Spectral Contrast ◽  
History Of ◽  
Phonetic Contrasts

Objective The purpose of this preliminary study was to determine if cleft type and/or history of otitis media with effusion (OM) contribute to backing of /t/ and/or /s/ in young children with and without repaired cleft palate (CP). Method Participants were 39 children ( M age = 36 months, range: 34–41). Ten children had repaired unilateral cleft lip and palate (CLP), nine had repaired CP only, 12 had no clefts but histories of OM, and eight were typically developing (TD) without clefts or OM history. All children were video- and audio-recorded during administration of the Goldman-Fristoe Test of Articulation–Third Edition (GFTA-3). Standard scores of articulation, frequency of alveolar backing, and first spectral moments of the /t/−/k/ and /s/−/ʃ/ phonetic contrasts were obtained. Results Children with CLP had lower GFTA-3 scores than both TD ( p = .012) and OM ( p = .001) groups. Fisher's exact test showed that significantly more children with CLP backed alveolar targets, mostly /s/, than children with CP ( p = .020). Children with CLP also had (a) reduced /t/−/k/ spectral difference compared to TD children ( p = .016) and (b) reduced /s/−/ʃ/ spectral difference compared to both children with CP ( p = .010) and children with OM ( p = .018). Children with OM had reduced /t/−/k/ spectral difference compared to TD children ( p = .009). Conclusions Cleft type contributes to alveolar backing and reduced spectral contrast of /s/−/ʃ/ in 3-year-old children with repaired CP. History of OM affects spectral contrast of /t/−/k/ in noncleft children. Etiology and clinical implications of alveolar backing are discussed.

Hearing and otitis media with effusion in young adults with cleft lip and palate

2012 ◽  
Vol 132 (9) ◽  
pp. 959-966 ◽  
Author(s):  
Traci Flynn ◽  
Claes Möller ◽  
Anette Lohmander ◽  
Lennart Magnusson
Keyword(s):  
Young Adults ◽  
Otitis Media ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Otitis Media With Effusion

scholarly journals Ear Findings in Post Surgical Cleft Palate Patients

2019 ◽  
Vol 4 (1) ◽  
pp. 621-624
Author(s):  
Sanjeev Kumar Thakur ◽  
Baleshwar Yadav ◽  
Raj Kumar Bedajit ◽  
Kailash Khaki Shrestha ◽  
Shankar Man Rai
Keyword(s):  
Cleft Palate ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Otitis Media With Effusion ◽  
Low Correlation ◽  
Middle Ear Ventilation ◽  
Tube Dysfunction ◽  
History Of

Introduction: Cleft lip and palate is one of the most common congenital anomaly, which contributes to eustachian tube dysfunction leading to impaired middle ear ventilation and middle ear pathology. It has been stated that the timely repair of cleft palate reduces the incidence of otitis media with effusion. Objective: To describe the ear findings in cleft palate patients who have undergone repair of cleft palate. Methodology: A total of 36 (20 male and 16 female) post cleft repair patients underwent Otoscopy and Tympanometry between January to December 2018. Cases with isolated cleft lip, ears with perforation of tympanic membrane and attico-antral disease were excluded. Results: The age range was from 4 years to 24 years, with a mean of 11.34 years. Maximum patients were of the age group of 10- 20 years (18, 50%) followed by that of 5-10 years range (15, 41.66%). Total number of ears examined were 72. Out of a total of 72 ears, 70 (97.2%) had abnormal otoscopic finding with dull tympanic membrane in 37 (51.39%) ears, retracted in 31 (43.05%) and bulging tympanic membrane in 2 (2.78%) cases. Type B curve was the commonest (36, 50%), followed by Type As (24, 33.3%). Type C curve was found in 11(15.3%) ears. Type A curve was found only in one ear. The duration of post-repair of cleft palate ranged from 6 months to up to 16 years with a mean of 8.52; 11 cases(30.56%) had history of repair of cleft palate of more than 10 years duration.16 cases (44.44%) had that of more than 5 years and 9 cases (25%) had less than 5 years history of duration of repair. When correlation was done statistically, the tympanometry findings and duration of repair had a very low correlation (Table 5). The time period of repair had no significant effect on tympanometric ear findings. Conclusion Abnormal otoscopic findings and tympanometric findings were common in post cleft palate repaired patients. The duration of cleft palate repair had low correlation to the tympanometric ear findings.

scholarly journals FREQUENCY OF OTITIS MEDIA WITH EFFUSION IN CLEFT PALATE CHILDREN

2019 ◽  
Vol 17 (2) ◽  
pp. 52-55
Author(s):  
Altaf Hussain ◽  
Wajahat Ullah Bangash ◽  
Muhammad Ismail Khan ◽  
Muhammad Afaq Ali ◽  
Ali Khan ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Otitis Media ◽  
Middle Ear ◽  
Cleft Lip ◽  
Otitis Media With Effusion ◽  
Pure Tone Audiometry ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Type B ◽  
Cross Sectional

Background: Children with cleft palate oftenly present with otitis media with effusion. The objective of this study was to determine the frequency of otitis media with effusion among cleft palate children. Material & Methods: This cross-sectional study was carried out in the Department of ENT, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from June 2017 to December 2018. Ninety patients were selected through consecutive sampling technique. All children 3-10 years of age with cleft palate were included. Patients with combined cleft palate and cleft lip were excluded. All patients underwent otoscopy and tympanometry. Type B tympanogram was considered as evidence of fluid in the middle ear. Later on patients with only Type B tympanogram underwent myringotomies. Results: Out of 90 (180 ears) patients 61 (67.78%) were males and 29 (32.22%) females. Mean age of the sample was 6.15±2.226 years (3-10, range 7 years). On otoscopic examination, 107/180 (59.45%) ears were suspected to have fluid in the middle ear. Type B tympanogram was detected in 125/180 (69.45%) ears. Only 38/90 (42.20%) patients (76/180 ears), underwent pure tone audiometry. Based on otoscopic, tympanometric and audiometric findings, myringotomies were performed in 125/180 (69.45%) ears. At myringotomy fluid was present in middle ear space of 98/180 (78.4%) ears. Out of total 180 ears the true frequency of otitis media with effusion was 98/180 (54.45%). Conclusions: The frequency of otitis media with effusion in patients with cleft palate is high. Tympanometry is fairly sensitive in diagnosing this condition in these patients.

Hearing Thresholds in Young Children With Otitis Media With Effusion With and Without Cleft Palate

2019 ◽  
Vol 57 (5) ◽  
pp. 616-623 ◽  
Author(s):  
Birgitta Tengroth ◽  
Anette Lohmander ◽  
Christina Hederstierna
Keyword(s):  
Hearing Loss ◽  
Cleft Palate ◽  
Otitis Media ◽  
Cleft Lip ◽  
Otitis Media With Effusion ◽  
University Hospital ◽  
Significant Group ◽  
Hearing Thresholds ◽  
Brainstem Response ◽  
Prospective Longitudinal

Objective: 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.

The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts

2009 ◽  
Vol 73 (10) ◽  
pp. 1441-1446 ◽  
Author(s):  
Traci Flynn ◽  
Claes Möller ◽  
Radoslava Jönsson ◽  
Anette Lohmander
Keyword(s):  
Otitis Media ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Otitis Media With Effusion ◽  
High Prevalence
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