Department of Pediatrics, Division of Craniofacial Medicine, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA.
University of Washington, School of Medicine, Seattle, WA, USA.
Int J Pediatr Otorhinolaryngol. 2022 Nov;162:111295. doi: 10.1016/j.ijporl.2022.111295. Epub 2022 Sep 5.
To describe the hearing thresholds of children under 3 years of age with cleft palate with or without cleft lip.
This retrospective study from a tertiary care children's hospital included children with cleft palate ± cleft lip born between January 01, 2008, and December 31, 2015. All patients who had the initial palate repair at our institution and at least one behavioral audiogram were included. Behavioral audiograms collected either in the sound field or under insert earphones showed results from the better hearing ear. We collected demographic information, cleft type, parent report of newborn hearing screen, syndrome diagnosis, comorbid conditions, and dates of tympanostomy tube placement and palatoplasty. The main outcome measure was hearing status as measured by behavioral audiograms, and, for a subset of patients, brainstem auditory evoked responses (BAER). Results were grouped by test type (behavioral vs BAER) and characteristics at time of testing (pre- or post-palatoplasty, with or without tympanostomy tube placement) to evaluate the range of severity of hearing loss.
Three hundred and sixty patients were included in the cohort. The cohort had two groups: Group 1 included 37 patients who had BAER results prior to surgery and behavioral audiogram results post-surgery; Group 2 included 322 patients who had behavioral audiograms pre-surgery (n = 206) and/or post-surgery (n = 215). The median age of patients at time of BAER in Group 1 was 3.00 months [IQR: 1.00,3.75]; pre-surgery BAER results showed mild (45.9%, n = 17) or moderate hearing loss (29.7%, n = 11) by this age. Patients in Group 2 with pre-surgery behavioral audiograms had a median age of 12.00 months [IQR: 11.00, 14.00] at time of audiogram. Most patients had a mild (33.5%, n = 69) or moderate hearing loss (31.1%, n = 64). Post-surgery, patients had a median age of 13.00 months [IQR: 11.00, 15.00] at time of hearing assessment and typically had normal hearing (86.0%, n = 185). In most patients, hearing improved after palate repair with concurrent tympanostomy tube placement.
Most patients with cleft palate ± cleft lip had evidence of mild or moderate hearing loss prior to cleft palate repair, and hearing loss was evident from early infancy. Hearing improved after concurrent tympanostomy tube placement and palatoplasty. Further research is needed to understand the clinical significance of untreated transient hearing loss during the first year of life in this patient population.
描述伴有或不伴有唇裂的腭裂儿童的听力阈值。
这是一项来自三级儿童医院的回顾性研究，纳入了 2008 年 1 月 1 日至 2015 年 12 月 31 日期间出生的伴有或不伴有唇裂的腭裂患儿。所有在我院初次行腭裂修复术且至少有一次行为测听的患者均被纳入研究。收集的行为测听结果来自声场或插入式耳机，来自听力较好的耳朵。我们收集了人口统计学信息、裂隙类型、新生儿听力筛查的父母报告、综合征诊断、合并症以及鼓膜置管和腭裂修复术的日期。主要结局测量指标为行为测听结果所反映的听力状况，对于部分患者，还包括脑干听觉诱发电位（BAER）。根据测试类型（行为测听与 BAER）和测试时的特征（腭裂修复术前或术后、是否有鼓膜置管）对结果进行分组，以评估听力损失的严重程度范围。
共有 360 名患者被纳入研究队列。该队列有两个组：第 1 组包括 37 名在手术前接受 BAER 检查且在手术后接受行为测听检查的患者；第 2 组包括 322 名在手术前（n=206）和/或手术后（n=215）接受行为测听检查的患者。第 1 组患者在 BAER 检查时的中位年龄为 3.00 个月[IQR：1.00，3.75]；在这个年龄段，术前 BAER 结果显示有轻度（45.9%，n=17）或中度听力损失（29.7%，n=11）。第 2 组在手术前有行为测听检查的患者在进行听力评估时的中位年龄为 12.00 个月[IQR：11.00，14.00]。大多数患者有轻度（33.5%，n=69）或中度听力损失（31.1%，n=64）。术后，患者在接受听力评估时的中位年龄为 13.00 个月[IQR：11.00，15.00]，通常听力正常（86.0%，n=185）。在大多数患者中，腭裂修复术同期行鼓膜置管后听力得到改善。
大多数伴有或不伴有唇裂的腭裂患儿在腭裂修复术前有轻度或中度听力损失的证据，并且听力损失在婴儿早期就已经存在。在同期行鼓膜置管和腭裂修复术后，听力得到改善。需要进一步研究以了解在该患者人群中，生命第一年未经治疗的短暂性听力损失的临床意义。
