To describe the impact of timing of tympanostomy tube insertion on the number of tubes received and complications in children with routine tube placement.
Design:
Retrospective case series.
Setting:
Tertiary care children’s hospital.
Participants:
Records from a consecutive sample of 401 children with cleft palate were reviewed. Sixty-five patients with isolated cleft palate and 82 patients with cleft lip and palate had follow-up until 5 years of age and were included.
Interventions:
Tympanostomy tubes.
Main Outcome Measure(s):
Number of tubes received and tube-related complications. The hypothesis was formulated prior to data collection.
Results:
Males comprised 55.8% of included patients, and tubes were placed in 98.6% of patients at a median age of 6.5 months. Effusion was documented at first tube placement for 96.5% of patients. Most (67.4%) patients required replacement of tubes, and 10.6% required long-term tubes. Complications included otorrhea (71.0%), myringosclerosis (35.2%), granulation (22.8%), perforation (17.9%), retained tubes (5.5%), and cholesteatoma (1.4%). Cleft lip and palate (P < .001) and otorrhea (P = .023) were associated with tube placement before palatoplasty. Patients with tube placement before palatoplasty (P = .033), genetic disorders (P = .007), failed newborn hearing screen (P = .012), otorrhea (P < .001), and granulation (P < .001) received more tubes.
Conclusions:
Nearly universal effusion in patients with cleft palate supports the need for routine tube placement. The potential for otorrhea and requiring more tubes should be weighed against the risks associated with prolonged effusion when considering tube placement before palatoplasty.
AhnJHKangWSKimJHKohKSYoonTH. Clinical manifestation and risk factors of children with cleft palate receiving repeated ventilating tube insertions for treatment of recurrent otitis media with effusion. Acta Otolaryngol. 2012;132(7):702–707.
2.
AlperCMLoseeJEMandelEMSerokyJTSwartsJDDoyleWJ. Pre- and post-palatoplasty Eustachian tube function in infants with cleft palate. Int J Pediatr Otorhinolaryngol. 2012;76(3):388–391.
3.
CasselbrantMLMandelEMKurs-LaskyMRocketteHEBluestoneCD. Otitis media in a population of black American and white American infants, 0-2 years of age. Int J Pediatr Otorhinolaryngol. 1995;33(1):1–16.
4.
CurtinGMessnerAHChangKW. Otorrhea in infants with tympanostomy tubes before and after surgical repair of a cleft palate. Arch Otolaryngol Head Neck Surg. 2009;135(8):748–751.
5.
DhillonRS. The middle ear in cleft palate children pre and post palatal closure. J R Soc Med. 1998;81(12):710–713.
6.
GaniBKinshuckAJSharmaR. A review of hearing loss in cleft palate patients. Int J Otolaryngol. 2012;2012:6.
7.
GordonASJean-LouisFMortonRP. Late ear sequelae in cleft palate patients. Int J Pediatr Otorhinolaryngol. 1988;15(2):149–156.
8.
GoudySLottDCanadyJSmithRJ. Conductive hearing loss and otopathology in cleft palate patients. Otolaryngol Head Neck Surg. 2006;134(6):946–948.
9.
GrantHRQuineyREMercerDMLodgeS. Cleft palate and glue ear. Arch Dis Child. 1988;63(2):176–179.
10.
HubbardTWParadiseJLMcWilliamsBJElsterBATaylorFH. Consequences of unremitting middle-ear disease in early life. Otologic, audiologic, and developmental findings in children with cleft palate. N Engl J Med. 1985;312(24):1529–1534.
11.
KayDJNalsonMRosenfeldRM. Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg. 2001;124(4):374–380.
12.
KobayashiHSakumaTYamadaNSuzakiH. Clinical outcomes of ventilation tube placement in children with cleft palate. Int J Pediatr Otorhinolaryngol. 2012;76(5):718–721.
13.
KuoCLTsaoYHChengHMLienCFHsuCHHuangCYShiaoAS. Grommets for otitis media with effusion in children with cleft palate: a systematic review. Pediatrics. 2014;134(5):983–994.
14.
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.
15.
LiWShangWYuAHZhangXHLiuYXWanXMJiaMYLiNY. Early treatment of middle ear disease in cleft palate infants. Hua Xi Kou Qiang Yi Xue Za Zhi. 2007;25(5):458–462.
16.
LiuLSunYGMaLZhaoWWuR. Effect of ventilation tube insertion on otitis media with effusion in cleft palate children. Zhonghua Er Bi Yan Hou Ke Za Zhi. 2004;39(4):216–218.
17.
MaheshwarAAMillingMAKumarMClaytonMIThomasA. Use of hearing aids in the management of children with cleft palate. Int J Pediatr Otorhinolaryngol. 2002;66(1):55–62.
18.
ParadiseJL. Management of middle ear effusions in infants with cleft palate. Ann Otol Rhinol Laryngol. 1976;85(2 suppl 25 pt 2):285–288.
19.
ParadiseJLBluestoneCDFelderH. The universality of otitis media in 50 infants with cleft palate. Pediatrics. 1969;44(1):35–42.
20.
ParadiseJLCampbellTFDollaghanCAFeldmanHMBernardBSColbornDKRocketteHEJanoskyGEPitcairnDLKurs-LaskyM. Developmental outcomes after early or delayed insertion of tympanostomy tubes. N Engl J Med. 2005;353(6):576–586.
21.
ParadiseJLDollaghanCACampbellTFFeldmanHMBernardBSColbornDKRocketteHEJanoskyJEPitcairnDLKurs-LaskyM. 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.
22.
ParadiseJLFeldmanHMCampbellTFDollaghanCAColbornDKBernardBSRocketteHEJanoskyJEPitcairnDLSaboDL. Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years. N Engl J Med. 2001;344(16):1179–1187.
23.
ParadiseJLFeldmanHMCampbellTFDollaghanCARocketteHEPitcairnDLSmithCGColbornDKBernardBSKurs-LaskyM. Tympanostomy tubes and developmental outcomes at 9 to 11 years of age. N Engl J Med. 2007;356(3):248–261.
24.
ParadiseJLRocketteHEColbornDKBernardBSSmithCGKurs-LaskyMJanoskyJE. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics. 1997;99(3):318–333.
25.
PhuaYSSalkeldLJde ChalainTM. Middle ear disease in children with cleft palate: protocols for management. Int J Pediatr Otorhinolaryngol. 2009;73(2):307–313.
26.
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.
27.
RobinsonPJLodgeSJonesBMWalkerCCGrantHR. The effect of palate repair on otitis media with effusion. Plast Reconstr Surg. 1992;89(4):640–645.
28.
RobsonAKBlanshardJDJonesKAlberyEHSmithIMMawAR. A conservative approach to the management of otitis media with effusion in cleft palate children. J Laryngol Otol. 1992;106(9):788–792.
29.
RosenfeldRMShinJJSchwartzSRCogginsRGagnonLHackellJMHoeltingDHunterLLKummerAWPayneSC. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(suppl 1):S1–S41.
30.
ShafferADFordMDChoiSSJabbourN. The impact of tympanostomy tubes on speech and language development in children with cleft palate. Otolaryngol Head Neck Surg. 2017;157(3):504–514.
31.
ShawRRichardsonDMcMahonS. Conservative management of otitis media in cleft palate. J Craniomaxillofac Surg. 2003;31(5):316–320.
32.
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.
33.
SmithLKGubbelsSPMacArthurCJMilczukHA. The effect of the palatoplasty method on the frequency of ear tube placement. Arch Otolaryngol Head Neck Surg. 2008;134(10):1085–1089.
34.
SpilsburyKHaJFSemmensJBLanniganF. Cholesteatoma in cleft lip and palate: a population-based follow-up study of children after ventilation tubes. Laryngoscope. 2013;123(8):2024–2029.
35.
StoolSERandallP. Unexpected ear disease in infants with cleft palate. Cleft Palate J. 1967;4:99–103.
