Abstract
ObjectiveDifferent surgical techniques and management approaches have been introduced to manage the cleft palate (CP) and its complications, such as otitis media with effusion (OME) and auditory problems. The optimal method, as well as the ideal time for palatoplasty and ventilation tube insertion, are the subject of controversy in the literature. We aimed to evaluate The Effect of Intervelar Veloplasty under Magnification (Sommerlad’s Technique) without Tympanostomy on Middle Ear Effusion in Cleft Palate Patients.Methodsnon-syndromic cleft palate patients from birth to 24 months who needed primary palatoplasty from April 2017 to 2019 were enrolled in this study. intravelar veloplasty (IVVP) surgery under magnification has been done by the same surgeon. Likewise, Otoscopy, Auditory Brainstem Response (ABR), and tympanometry were performed for all the patients before and six months after palatoplasty.ResultsTympanograms were classified into two categories according to shape and middle ear pressure, and it was done in 42 children (84 ears). Type B curve was seen in 40 cases (80 ears) before surgery which reduced significantly (P < 0.005) to 12 cases in the left ear and 14 cases in the right ear after surgery. So, after surgery, 70 % of the tympanogram of left ears and 66.6 % of the tympanogram of Rt ears were in normal condition (type A tympanometry). ABR was done for 43 patients (86 ears) before surgery and six months after palatoplasty. Data were shown that 40 of the patients had mild to moderate hearing loss before surgery, which reduced significantly (P < 0.005) to 9 in the left ear and 11 in the right ear after palatoplasty. So, after surgery, 79 % of ABR of left ears and 73.8 % of ABR of right ears were in normal status (normal hearing threshold).ConclusionsIntervelar veloplasty under magnification (Sommerlad’s technique) significantly improved the middle ear effusion without the need for tympanostomy tube insertion.
Highlights
The orofacial cleft with the prevalence of one in 700 births is considered the most common birth anomaly [1]
Insertion of ventilation tubes has been considered as the optimal treatment for otitis media in patients with cleft palate, even though controversy surrounds the timing of ear tube placement
No long-term research has been conducted to evaluate the effect of early placement of ventilation tubes on speech outcomes in patients born with cleft palate
Summary
The orofacial cleft with the prevalence of one in 700 births is considered the most common birth anomaly [1]. Persistent eustachian tube dysfunction is thought to be the primary factor responsible for the higher rates of more serious middle ear pathology observed in children with cleft palate, such as tympanic membrane perforation, middle ear atelectasis, cholesteatoma, and otitis media with effusion (OME) [2]. Insertion of ventilation tubes has been considered as the optimal treatment for otitis media in patients with cleft palate, even though controversy surrounds the timing of ear tube placement. Concerning excessive compliance with the eustachian tube, high rates of otorrhea following myringotomy and ventilation tube insertion before palatoplasty have been reported [5]. No long-term research has been conducted to evaluate the effect of early placement of ventilation tubes on speech outcomes in patients born with cleft palate. Various surgical procedures have been introduced to correct the anatomic structures of patients with cleft palate along eliminate the problem
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