Long-term Outcome of the Management of Otitis Media with Effusion in Children with and Without Cleft Palate Using the House-brand Polyethylene Ventilation Tube Insertion

Kitirat  Ungkanont; Alisa  Tabthong; Chulaluk  Komoltri; Amornrut   Leelaporn; Vannipa  Vathanophas; Archwin  Tanphaichitr; Thidarat  Wensanthia

doi:10.33192/Smj.2021.32

Authors

Kitirat Ungkanont Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, https://orcid.org/0000-0003-0923-1908
Alisa Tabthong Uthaithani Hospital, Mueang District, Uthai Thani, Thailand https://orcid.org/0000-0003-2548-8375
Chulaluk Komoltri Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0001-8620-1126
Amornrut Leelaporn Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0003-3989-151X
Vannipa Vathanophas Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0001-5633-0787
Archwin Tanphaichitr Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0001-7871-1724
Thidarat Wensanthia Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand https://orcid.org/0000-0003-1147-8619

DOI:

https://doi.org/10.33192/Smj.2021.32

Keywords:

Cleft palate, otitis media with effusion, ventilation tube

Abstract

Objective: To study the long-term outcome of otitis media with effusion in children with and without cleft palate treated with the same protocol of ventilation tube insertion.
Materials and Methods: A retrospective cohort study was conducted in eighty-five children with cleft palate and 80 children without cleft palate who had otitis media with effusion and had follow-up between 2001 and 2019. Both groups were treated with ventilation tube insertion for longstanding middle ear effusion more than 90 days. The main outcome was the cumulative incidence of surgical management, time of the indwelling ventilation tubes, conditions of the tympanic membrane, and the hearing outcome.
Results: At 24 months old, 63.5% of children with cleft palate and 11.3% of children without cleft palate had their first ventilation tube insertion. Repeated surgery was done in 81.2% of children with cleft palate and 50% of children without cleft palate (p < 0.001). The median duration of the indwelling tube was 11.3 months in the children with cleft palate and 12.4 months in the non-cleft children (p = 0.82). At the end of the study, 63.7% of children without cleft palate and 43.5% of children with cleft palate had normal tympanic membrane (p = 0.009). The hearing outcomes of children with and without cleft palate were 20.7 dB and 19.3 dB, respectively.
Conclusion: Children with and without cleft palate were managed under the same guideline and the hearing outcome was favorable in both groups.

References

1. Deleyiannis FWB, Maguire RC. Congenital malformations of the mouth and pharynx: orofacial cleft and related syndromes. In: Bluestone CD, Healy GB, Simons JP, editors. Pediatric Otolaryngology. 2. 5th ed. Shelton: People's Medical Publishing House-USA; 2014. p. 1879-84.
2. Skinner ML, Tunkel DE. Primary care of infants and children with cleft palate. In: Bluestone CD, Healy GB, Simons JP, editors. Pediatric Otolaryngology. 2. 5th ed. Shelton: People's Medical Publishing House-USA; 2014. p. 1879-84.
3. Takasaki K, Sando I, Balaban CD, Ishijima K. Postnatal development of eustachian tube cartilage. A study of normal and cleft palate cases. International journal of pediatric otorhinolaryngology. 2000;52(1):31-6.
4. Heidsieck DS, Smarius BJ, Oomen KP, Breugem CC. The role of the tensor veli palatini muscle in the development of cleft palate-associated middle ear problems. Clinical oral investigations. 2016;20(7):1389-401.
5. Karanth TK, Whittemore KR. Middle-ear disease in children with cleft palate. Auris, nasus, larynx. 2018;45(6):1143-51.
6. da Silva DP, Collares MV, da Costa SS. Effects of velopharyngeal dysfunction on middle ear of repaired cleft palate patients. Cleft Palate Craniofac J. 2010;47(3):225-33.
7. Garcia-Vaquero C, Mir C, Graterol D, Ortiz N, Rochera-Villach MI, ME LL, et al. Otologic, audiometric and speech findings in patients undergoing surgery for cleft palate. BMC Pediatr. 2018;18(1):350.
8. Kobayashi H, Sakuma T, Terao H, Sanbe T, Suzaki H, Ohkubo F. Palatoplasty and growth of the temporal bone mastoid air cells. Cleft Palate Craniofac J. 2012;49(5):541-5.
9. Kobayashi H, Sakuma T, Yamada N, Suzaki H. Clinical outcomes of ventilation tube placement in children with cleft palate. International journal of pediatric otorhinolaryngology. 2012;76(5):718-21.
10. Alper CM, Losee JE, Seroky JT, Mandel EM, Richert BC, Doyle WJ. Resolution of Otitis Media With Effusion in Children With Cleft Palate Followed Through Five Years of Age. Cleft Palate Craniofac J. 2016;53(5):607-13.
11. Ponduri S, Bradley R, Ellis PE, Brookes ST, Sandy JR, Ness AR. 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):30-8.
12. Phua YS, Salkeld LJ, de Chalain TM. Middle ear disease in children with cleft palate: protocols for management. International Journal of Pediatric Otorhinolaryngology. 2009;73(2):307-13.
13. Rosenfeld RM, Schwartz SR, Pynnonen MA, Tunkel DE, Hussey HM, Fichera JS, et al. Clinical practice guideline: Tympanostomy tubes in children. Otolaryngology--head and neck surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2013;149(1 Suppl):S1-35.
14. Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngology--head and neck surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2016;154(1 Suppl):S1-s41.
15. Kuo CL, Lien CF, Chu CH, Shiao AS. Otitis media with effusion in children with cleft lip and palate: a narrative review. International Journal of Pediatric Otorhinolaryngology. 2013;77(9):1403-9.
16. Ungkanont K, Boonyabut P, Komoltri C, Tanphaichitr A, Vathanophas V. Surveillance of Otitis Media With Effusion in Thai Children With Cleft Palate: Cumulative Incidence and Outcome of the Management. Cleft Palate Craniofac J. 2018;55(4):590-5.
17. Smillie I, Robertson S, Yule A, Wynne DM, Russell CJ. Complications of ventilation tube insertion in children with and without cleft palate: A nested case-control comparison. JAMA Otolaryngology-- Head & Neck Surgery. 2014;140(10):940-3.
18. Huang CY, Wu CS, Tang CH, Wang MC, Kuo TY, Tu TY. Palatoplasty decreases the re-insertion rate of middle ear ventilation tube in cleft palate children - A population-based birth cohort study. Acta Otolaryngol. 2016;136(8):768-74.
19. Kim E, Kanack MD, Dang-Vu MD, Carvalho D, Jones MC, Gosman AA. Evaluation of Ventilation Tube Placement and Long-term Audiologic Outcome in Children With Cleft Palate. Cleft Palate Craniofac J. 2017;54(6):650-5.
20. Ahn JH, Kang WS, Kim JH, Koh KS, Yoon TH. 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):702-7.
21. Sundman H, Flynn T, Tengroth B, Lohmander A. ABR thresholds in infants born with CLP and OME and infants with OME. International Journal of Pediatric Otorhinolaryngology. 2016;81:21-5.
22. Tengroth B, Lohmander A, Hederstierna C. Hearing Thresholds in Young Children With Otitis Media With Effusion With and Without Cleft Palate. Cleft Palate Craniofac J. 2020;57(5):616-23.