Kappen I F P M, Schreinemakers J B S, Oomen K P Q, Bittermann D, Kon M, Breugem C C, Mink van der Molen A B
Department of Plastic Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
Department of ENT Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
Int J Pediatr Otorhinolaryngol. 2017 Mar;94:76-81. doi: 10.1016/j.ijporl.2016.12.030. Epub 2016 Dec 26.
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.
评估接受两阶段腭裂修复术治疗的单侧完全性唇腭裂（UCLP）患者的长期听力和中耳状况。
本回顾性研究纳入了49例年龄在17岁及以上的UCLP患者。这些患者被邀请到荷兰一家颅面外科三级中心接受多学科长期随访。耳鼻喉科评估包括鼓室导抗图和纯音听力测定。查阅病历以获取医疗和手术史。
总体而言，19.4%的患者存在显著的长期听力损失（PTA>20 dB），其中21.5%的患者为传导性听力损失。在大多数患者（70%）中，这种听力损失在高频时更为明显。25%的患者高弗莱彻指数显示听力阈值高于20 dB。78.7%的患者至少放置过一次通气管。通气管插入频率与鼓膜顺应性降低（B型鼓室导抗图）的发生率以及咽成形术的需求呈正相关。
本研究报告了3岁时硬腭闭合的UCLP患者的长期听力结果。我们的患者中有19.4%观察到持续性听力损失（PTA>20 dB），主要发生在高频。通气管放置与鼓膜顺应性降低和听力损失（气导PTA）风险增加有关。我们幼儿期腭咽闭合不全的高发生率可能与咽鼓管功能障碍有关，这可能导致了这些结果。
