Hearing levels and age in cleft palate patients

doi:10.1016/0165-5876(96)01412-7

International Journal of Pediatric Otorhinolaryngology

Volume 37, Issue 3, November 1996, Pages 227-242

https://doi.org/10.1016/0165-5876(96)01412-7 Get rights and content

Abstract

Tonal audiometry was used to compare hearing levels in patients with bilateral cleft lip and palate (BCLP) (57 patients), unilateral cleft lip and palate (UCLP) (124 patients) and isolated cleft palate (ICP) (62 patients), and according to age groups. Patients with isolated cleft palate showed greater improvement in hearing level with age than patients with UCLP and BCLP; as adults they showed the lowest frequency of ears with hearing level of less than 40 dB, and the highest frequency of ears with hearing levels of 11–20 dB. Patients with BCLP had a higher frequency of ears with a hearing level of 21–40 dB during early childhood and adult age than patients with ICP. Patients with UCLP and BCLP showed a slower decrease with age in the frequency of ears with hearing loss than patients with ICP; the hearing level in patients with UCLP and BCLP improved only in groups with hearing levels of 21–40 dB, while those with hearing levels above 40 dB showed no significant improvement with age.

Conservative therapeutic methods for normalization of the hearing level and middle ear state were found to be inefficient in the cleft palate population Thus, early surgical treatment (ventilation tube insertion) appears to be the therapy of choice.

References (15)

M. Bennet
The older cleft palate patient, a clinical otologic-audiologic study
Laryngoscope
(1972)
A. Bylander
Comparation of Eustachian tube function in children and adults with normal ears
Ann. Otol. Laryngol
(1980)
B. Drettner
The nasal airway and hearing in patients with cleft palate
Acta Otolaryngol.
(1952)
M. Fara et al.
Abnormal anatomy of the muscles of palatopharyngeal closure in cleft palates
Plast. Reconstr. Surg.
(1970)
J. Handžić et al.
Hearing thresholds in cleft lip or palate patients
Chir. Maxillofac. Plast.
(1989)
J.C. Heller et al.
Audiologic and otologic evaluation of cleft palate children
Cleft Palate J.
(1970)
C.A. Holborow
Deafness associated with cleft palate
J. Laryngol. Otol.
(1962)

There are more references available in the full text version of this article.

Cited by (42)

Effect of prosthetic management of congenital cleft lip and palate on the middle ear function of infants: A clinical trial
2024, Journal of Prosthetic Dentistry
Infants with a cleft palate often experience middle ear disease, a condition of great significance, and early prosthetic management of these infants is essential. However, any correlation between prosthetic palatal obturation and middle ear function is unclear.
The purpose of this clinical trial was to assess whether prosthetic palatal obturation with a feeding appliance prevented or improved middle ear problems in infants with a cleft lip and palate.
Ten infants with congenital cleft lip and palate (20 ears) were referred to the Prosthodontics department immediately after birth. Assessment of the middle ear function by tympanometry as well as hearing quality by auditory brainstem response (ABR) was conducted before the prosthetic treatment (control readings). The middle ear function and hearing quality was followed up after the prosthetic treatment every month until surgical palatal closure (tenth month). The Friedman test was applied to compare data from the various study periods. When the results were significant, the Dunn post hoc test was conducted to compare the control first week readings with those of the later periods (α=.05 for all tests).
The preprosthetic readings of tympanometry in the first week were 90% Type A and 10% Type B for both right and left ears. Readings starting from the first to the fifth month revealed no statistically significant differences compared with the first week readings (P>.05). However, tympanometry readings starting from the sixth month (20% Type A and 80% Type B) until the tenth month (90% Type B and 10% Type C) for both ears represented a statistically significant difference compared with the first week readings (P≤.05). The preprosthetic readings of ABR in the first week showed that 90% of ears had normal hearing status and 10% had mild hearing loss. Readings starting from the first until the fifth month revealed no statistically significant differences compared with the first week readings (P>.05). However, ABR readings starting from the sixth month (20% normal hearing, 70% mild hearing loss, and 10% moderate hearing loss) until the tenth month (0% normal hearing, 80% mild hearing loss, and 20% moderate hearing loss) for both ears revealed a statistically significant difference compared with the first week readings (P≤.05).
Prosthetic palatal obturation with a feeding appliance plays a role in delaying rather than preventing the occurrence of otitis media with effusion in infants with a cleft lip and palate and could reduce the need for ventilation tubes.
Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial
2021, Brazilian Journal of Otorhinolaryngology
The association between the treatment of transverse maxillary deﬁciency and the recovery of hearing and voice functions has gained attention in recent years.
This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency
53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1 ± 1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups.
Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0–T1, T1–T2, T0–T2, and T0–T3 observation periods (p < 0.05). The significant increase was observed in right middle ear volumes during the T0–T1, T0–T2 and T0–T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p < 0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods.
Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.
Hearing status and behavioural patterns among school aged children with cleft lip and/or palate
2019, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
Therefore in our centre, it is recommended for annual hearing assessment of all CLP patients until age of 12 years old despite asymptomatic. Most types of clefts resulted in moderate to severe conductive hearing loss with the hearing loss among young children with non-syndromic cleft lip and palate is mainly moderate [7]. The degree of hearing loss in the current study ranged from mild hearing loss to moderately severe hearing loss with majority had mild conductive hearing loss (22.3%).
There is a dearth of studies on long term hearing status and behavioural patterns among cleft lip and/or palate children after their primary lip and palate closure in Malaysia. This study describes the audiology status and behavioural patterns in a group of school aged children with cleft lip and/or palate.
A cross sectional study was carried out where caretakers of cleft lip and/or palate were asked to complete the translated Malay language version of Strength Difficulties Questionnaire. The hearing status of the children was analyzed based on recent pure tone audiometric and tympanogram results. The patients’ age, gender, type of cleft pathology, age of palatal surgery and behavioural patterns were examined for their potential relationship with hearing status.
A total of 74 children (148 ears) aged between 7 and 17 years with cleft lip and/or palate were recruited. The result showed 37 ears (25.0%) had hearing loss with majority suffered from mild conductive hearing loss. There were 16 ears (10.8%) that had persistent middle ear effusion. Hearing improvement occurred when palatal repair was performed at the age of less than 1 year old. (p = 0.015) There was no significant relationship between patients' gender, age, type of cleft and history of myringotomy with their hearing status. In terms of behavioural patterns, 16.3% were abnormal for total behavioural score, 39.2% for peer problem and 17.6% for conduct problem. For prosocial behaviour, 16.3% were rated low and very low. There was fair correlation between age and hyperactivity problems (r = 0.44). Patients’ gender, type of cleft pathology, had been teased apart and hearing status was found not related to behavioural problems.
Cleft lip and/or palate patients have a good longterm hearing outcome. Majority had normal hearing and if there is hearing impairment, it is only a mild loss. Early palatal repair surgery before the age of 1 year can significantly reduce the risk of hearing loss. Cleft lip and/or palate patients experienced peer problems. There was no significant correlation between behavioural difficulty and hearing status among school-aged children with cleft lip and palate.
Middle-ear disease in children with cleft palate
2018, Auris Nasus Larynx
The objective of this review is to summarize all aspects of middle ear diseases in children with cleft palate (CP).
PubMed, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and The Cochrane Library were searched for English-language randomized control trials (RCTs), meta-analyses, systematic reviews and observational studies published through 31st July 2017.
Epidemiology and pathogenesis of middle ear diseases in children with cleft palate have been discussed in this review. Methods of Evaluation, CP surgeries, complications and follow up have been detailed for the same.
Evaluation of middle-ear disease in children with CP begins at birth by a newborn hearing screen. Tympanometry and otoscopy helps screen for middle-ear disease during follow-up visits. Ventilation tube may be placed when indicated based on the patient’s clinical course and presentation. Long-term follow up should be provided to look for the development of cholesteatoma.
Influence of infancy care strategy on hearing in children and adolescents: A longitudinal study of children with unilateral lip and /or cleft palate
2018, International Journal of Pediatric Otorhinolaryngology
To evaluate the relation between ventilation tube insertion, otitis media with effusion duration and otologic outcomes in unilateral cleft lip and/or cleft palate children from infancy to teenage age.
Retrospective longitudinal charts review of patients from the multidisciplinary cleft team of the University Hospital of Lausanne over a 30-year period. 146 charts from consecutive patients with non-syndromic unilateral cleft lip and/or cleft palate who were born between January 1986 and January 2003 were included.
The earlier in life a cleft child experience his first otitis media with effusion (OME), the worse his long-term hearing will be. Along with the age of onset of OME, we disclosed an influence of the duration of OME without ventilation tube (VT) insertion on short and long-term hearing outcomes. Different patterns were observed between cleft palate (CP) and cleft lip palate children (CLP), with a higher incidence of otitis media with effusion for the CLP group than the CP group. Direct positive relationship between VT insertion and hearing were disclosed and evaluation of long-term complications did not reveal significant relation with VT insertion. Of note, OME in CLP children led to a higher rate (but not statistically significant) of chronic ear complications than in the CP group, that may indicate more persistent OME or different adverse effect on the middle ear mucosa between CP and CLP children.
Individualized counseling should take into account different factors such as the type of cleft, the age of onset of OME and duration of OME, keeping in mind the adverse effect of persistent middle ear fluid. In the present report, results prone an early ventilation tube insertion to prevent short and long-term injury to the middle ear homeostasis, hearing loss and related issues.
Hearing sensitivity in adults with a unilateral cleft lip and palate after two-stage palatoplasty
2017, International Journal of Pediatric Otorhinolaryngology
To evaluate long-term hearing and middle ear status in patients treated for a unilateral complete cleft lip and palate (UCLP) by two-stage palatoplasty.
Forty-nine UCLP patients aged 17 years and older were included in this retrospective study. Patients were invited for a multidisciplinary long-term follow-up of their treatment at a tertiary center for craniofacial surgery in the Netherlands. ENT assessment included tympanometry and pure-tone audiometry. Medical files were searched for medical and surgical history.
In total, 19.4% of the patients had significant long-term hearing loss (PTA > 20 dB), comprising conductive hearing loss in 21.5% of the patients. In the majority (70%), this hearing loss was more pronounced at higher frequencies. In 25% the high fletcher index showed hearing thresholds above 20 dB. Ventilation tubes were placed at least once in 78.7% of the patients. The frequency of tube insertion was positively correlated with the incidence of reduced tympanic compliance (tympanogram type B) and the need for a pharyngoplasty.
The present study reports long-term hearing outcomes in UCLP patients with hard palate closure at 3 years of age. Persistent hearing loss was observed in 19.4% of our patients (PTA > 20 dB), mainly at the higher frequencies. Ventilation tube placement was associated with reduced tympanic compliance and higher risk on hearing loss (PTA air conduction). Our high incidence of velopharyngeal incompetence during early childhood, which is likely associated with Eustachian tube dysfunction, might have contributed to these results.

View all citing articles on Scopus

View full text

Research reportHearing levels and age in cleft palate patients

Abstract

The older cleft palate patient, a clinical otologic-audiologic study

Laryngoscope

Comparation of Eustachian tube function in children and adults with normal ears

Ann. Otol. Laryngol

The nasal airway and hearing in patients with cleft palate

Acta Otolaryngol.

Abnormal anatomy of the muscles of palatopharyngeal closure in cleft palates

Plast. Reconstr. Surg.

Hearing thresholds in cleft lip or palate patients

Chir. Maxillofac. Plast.

Audiologic and otologic evaluation of cleft palate children

Cleft Palate J.

Deafness associated with cleft palate

J. Laryngol. Otol.

Research report
Hearing levels and age in cleft palate patients