Otolaryngology Department, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Biomedical Research in Cancer Stem Cells, Vall d'Hebron Research Institute, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
BMC Pediatr. 2018 Nov 8;18(1):350. doi: 10.1186/s12887-018-1312-7.
Although considerable progress has been made in the last 30 years in the treatment of cleft palate (CP), a multidisciplinary approach combining examinations by a paediatrician, maxillofacial surgeon, otolaryngologist and speech and language pathologist followed by surgical operation is still required. In this work, we performed an observational cross-sectional study to determine whether the CP grade or number of ventilation tubes received was associated with tympanic membrane abnormalities, hearing loss or speech outcomes.
Otologic, audiometric, tympanometric and speech evaluations were performed in a cohort of 121 patients (children > 6 years) who underwent an operation for CP at the Vall d'Hebron Hospital, Barcelona from 2000 to 2014.
The most and least frequent CP types evaluated according to the Veau grade were type III (55.37%) and I (8.26%), respectively. A normal appearance of the membrane was observed in 58% individuals, of whom 55% never underwent ventilation ear tube insertion. No statistically significant associations were identified between the CP type and number of surgeries for insertion of tubes (p = 0.820). The degree of hearing loss (p = 0.616), maximum impedance (p = 0.800) and tympanic membrane abnormalities indicative of chronic otitis media (COM) (p = 0.505) among examined patients revealed no statistically significant association with the grade of CP. However, an association was identified between hypernasality and the grade of CP (p = 0.053), COM (p = 0.000), hearing loss (p = 0.000) and number of inserted ventilation tubes.
Although the placement of tympanic ventilation tubes has been accompanied by an increased rate of COM, it is still important to assess whether this is a result of the number of ventilation tubes inserted or it is intrinsic to the natural history of middle ear inflammatory disease of such patients. Our results do not support improvements in speech, hearing, or tympanic membrane abnormalities with more aggressive management of COM with tympanostomy tubes.
尽管在过去 30 年中，腭裂（CP）的治疗已经取得了相当大的进展，但仍需要多学科方法，包括儿科医生、颌面外科医生、耳鼻喉科医生和言语语言病理学家的检查，然后再进行手术。在这项工作中，我们进行了一项观察性横断面研究，以确定 CP 程度或接受的通气管数量是否与鼓膜异常、听力损失或言语结果相关。
在巴塞罗那 Vall d'Hebron 医院，对 2000 年至 2014 年期间接受 CP 手术的 121 名（>6 岁）患者进行了耳科学、听力计、鼓室压和言语评估。
根据 Veau 分级，评估的最常见和最不常见 CP 类型分别为 III 型（55.37%）和 I 型（8.26%）。58%的个体膜外观正常，其中 55%从未接受过通气耳管插入。CP 类型与管插入手术次数之间未发现统计学显著关联（p=0.820）。检查患者的听力损失程度（p=0.616）、最大阻抗（p=0.800）和提示慢性中耳炎（COM）的鼓膜异常（p=0.505）与 CP 程度之间无统计学显著关联。然而，鼻音过度与 CP 程度（p=0.053）、COM（p=0.000）、听力损失（p=0.000）和插入通气管数量之间存在关联。
尽管鼓膜通气管的放置伴随着 COM 发生率的增加，但仍有必要评估这是由于插入的通气管数量还是患者中耳炎症性疾病的自然史所致。我们的结果不支持更积极地通过鼓膜切开术管治疗 COM 可以改善言语、听力或鼓膜异常。
