Shaffer Amber D, Ford Matthew D, Choi Sukgi S, Jabbour Noel
1 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
2 Division of Cleft Craniofacial Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2017 Sep;157(3):504-514. doi: 10.1177/0194599817703926. Epub 2017 May 2.
Objective Describe the impact of hearing loss, tympanostomy tube placement before palatoplasty, and number of tubes received on speech outcomes in children with cleft palate. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods Records from 737 children born between April 2005 and April 2015 who underwent palatoplasty at a tertiary children's hospital were reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, sensorineural or mixed hearing loss, no tubes, first tubes after palatoplasty, or first clinic after 12 months of age. Data from 152 patients with isolated cleft palate and 166 patients with cleft lip and palate were analyzed using Wilcoxon rank-sum, χ, and Fisher exact test and logistic regression. Results Most patients (242, 76.1%) received tubes before palatoplasty. Hearing loss after tubes, but not before, was associated with speech/language delays at 24 months ( P = .005) and language delays ( P = .048) and speech sound production disorders (SSPDs, P = .040) at 5 years. Receiving tubes before palatoplasty was associated with failed newborn hearing screen ( P = .001) and younger age at first posttubes type B tympanogram with normal canal volume ( P = .015). Hearing loss after tubes ( P = .021), language delays ( P = .025), SSPDs ( P = .003), and velopharyngeal insufficiency ( P = .032) at 5 years and speech surgery ( P = .022) were associated with more tubes. Conclusion Continued middle ear disease, reflected by hearing loss and multiple tubes, may impair speech and language development. Inserting tubes before palatoplasty did not mitigate these impairments better than later tube placement.
目的 描述听力损失、腭裂修复术前鼓膜置管及置管数量对腭裂患儿言语结局的影响。研究设计 病例系列研究并进行病历回顾。研究地点 三级儿童专科医院。研究对象与方法 回顾了2005年4月至2015年4月期间在一家三级儿童专科医院接受腭裂修复术的737例患儿的病历。排除标准为在外部医院进行腭裂修复、继发腭完整、腭裂修复术后未进行言语评估、感音神经性或混合性听力损失、未置管、腭裂修复术后首次置管或12月龄后首次就诊。对152例单纯腭裂患儿和166例唇腭裂患儿的数据进行Wilcoxon秩和检验、χ²检验、Fisher确切概率检验及logistic回归分析。结果 大多数患儿（242例，76.1%）在腭裂修复术前接受了置管。置管后而非置管前的听力损失与24个月时的言语/语言发育迟缓（P = 0.005）、5岁时的语言发育迟缓（P = 0.048）及语音产生障碍（SSPDs，P = 0.040）相关。腭裂修复术前置管与新生儿听力筛查未通过（P = 0.001）及首次出现外耳道容积正常的B型鼓室图时年龄较小（P = 0.015）相关。5岁时置管后的听力损失（P = 0.021）、语言发育迟缓（P = 0.025）、SSPDs（P = 0.003）、腭咽闭合不全（P = 0.032）及言语手术（P = 0.022）与置管数量较多相关。结论 听力损失和多次置管所反映的持续性中耳疾病可能损害言语和语言发育。在腭裂修复术前置管并不比术后置管能更好地减轻这些损害。
