Kalaiarasi Raja, Syed Kamran A, Vijayakumar Chellappa, Varghese Ajoy M, John Mary
Otorhinolaryngology, Sri Lakshmi Narayana Institute of Medical Science, Puducherry, India.
Otorhinolaryngology, Christian Medical College Hospital, Vellore, India.
Cureus. 2018 Feb 8;10(2):e2175. doi: 10.7759/cureus.2175.
Introduction Orofacial clefts are associated with middle ear diseases, but the magnitude of this problem is not generally well appreciated. The aim of this study was to describe the middle ear findings and audiological profile in children with orofacial clefts. Materials and methods Children with orofacial clefts attending plastic surgery and otorhinolaryngology departments of a tertiary hospital over one-year duration were included in this study. Ninety-six children with orofacial clefts were identified. They were categorized age-wise as zero to five years, more than five years to 10 years, and more than 10 years to 15 years. They underwent a detailed ear, nose, and throat examination followed by audiological tests, including brainstem evoked response audiogram (BERA), pure tone audiogram (PTA), and tympanometry. Results Among 96 children with orofacial clefts, only 24 children (25%) had symptomatic ear problems, whereas on ear examination, 56 children (58.3%) had abnormal ear findings. Middle ear effusion (MEE) was the most common ear condition, and it was seen in 94 ears (48.9%). Cholesteatoma was noted in six children (3.1%). Out of 73 children in the zero to five age group, 58 children (79.5%) did not have any history of ear problem but 55.5% (81 ears) had features of MEE such as a dull tympanic membrane (TM). In the age group of more than five years to 10 years, only four children (28.5%) were symptomatic. Five children (55.5%) out of nine in the age group of more than 10 years had a symptomatic ear problem of which four children (44.4%) had chronic otitis media squamosal disease. The earlier age groups showed a trend of ear disease being asymptomatic compared to older children. Normal hearing was present in only 40 children (41.7%) and various degrees of hearing loss were seen in 56 children (58.3%). The mean air conduction threshold in the age group zero to five years, more than five years to 10 years, and more than 10 years were 33±8.3 decibels (dB), 25±6.2 dB, and 31.5±14 dB, respectively. Out of 144 ears (72 children) in the asymptomatic group, 67 ears (46.5%) had normal hearing. Seventy-seven ears (53.5%) had some degree of hearing loss. Mean air conduction hearing loss in the asymptomatic group was 29.8±7.3 dB. Conclusion This study highlights the higher incidence of middle ear diseases compared to the presenting symptoms in children with orofacial clefts. This stresses on the need for a detailed otological evaluation to identify any middle ear pathology so that timely intervention can be taken.
引言
口面部裂隙与中耳疾病有关，但这一问题的严重程度通常未得到充分认识。本研究的目的是描述口面部裂隙患儿的中耳检查结果及听力学特征。
材料与方法
本研究纳入了一家三级医院整形外科和耳鼻咽喉科在一年期间接诊的口面部裂隙患儿。共确定了96例口面部裂隙患儿。他们按年龄分为0至5岁、5岁以上至10岁、10岁以上至15岁三组。他们接受了详细的耳鼻喉检查，随后进行了听力学测试，包括脑干诱发反应听力图（BERA）、纯音听力图（PTA）和鼓室图。
结果
在96例口面部裂隙患儿中，只有24例（25%）有耳部症状，而耳部检查时，56例（58.3%）有耳部异常发现。中耳积液（MEE）是最常见的耳部疾病，94耳（48.9%）出现该病症。6例患儿（3.1%）发现有胆脂瘤。在0至5岁年龄组的73例患儿中，58例（79.5%）无耳部疾病史，但55.5%（81耳）有中耳积液特征，如鼓膜（TM）混浊。在5岁以上至10岁年龄组中，只有4例患儿（28.5%）有症状。10岁以上年龄组的9例患儿中有5例（55.5%）有耳部症状，其中4例患儿（44.4%）患有慢性中耳鳞状上皮病。与年龄较大的儿童相比，年龄较小的组显示出耳部疾病无症状的趋势。只有40例患儿（41.7%）听力正常，56例患儿（58.3%）有不同程度的听力损失。0至5岁、5岁以上至10岁、10岁以上年龄组的平均气导阈值分别为33±8.3分贝（dB）、25±6.2 dB和31.5±14 dB。在无症状组的144耳（72例患儿）中，67耳（46.5%）听力正常。77耳（53.5%）有一定程度的听力损失。无症状组的平均气导听力损失为29.8±7.3 dB。
结论
本研究强调了口面部裂隙患儿中耳疾病的发生率高于其出现的症状。这突出了需要进行详细的耳科评估以确定任何中耳病变，以便能够及时进行干预。
