title: Middle ear disease in children with congenital velopharyngeal insufficiency.
abstract: OBJECTIVE
  To examine the incidence and natural history of middle ear disease in children with congenital velopharyngeal insufficiency (VPI) without cleft palate.
  
  
  METHODS
  Children with congenital VPI attending the combined cleft clinic at a tertiary cleft center. The diagnosis of congenital VPI in all cases was confirmed be the observation of hypernasality, nasal air escape, or both by a speech and language therapist and the demonstration of incompetence of the velopharyngeal sphincter by means of nasoendoscopy or videofluoroscopy. Children with overt cleft palate or postsurgical VPI were excluded.
  
  
  METHODS
  The children's medical records were reviewed, and a questionnaire regarding history of ear problems was sent to all parents. Children were divided into those with Pruzansky type I VPI (showing bifid uvula, midline diastasis of soft palate, or submucous cleft of the hard palate) and Pruzansky type II VPI (no visible stigmata).
  
  
  METHODS
  Incidence of reported ear problems, ear infections, hearing loss, and surgical intervention for middle ear disease in the whole group and in each of the subgroups.
  
  
  RESULTS
  Seventy-one parents returned completed questionnaires. The overall incidence of middle ear disease was 63%, with 28% reported to have below-normal hearing. There was no significant difference between children with Pruzansky types I and II VPI with respect to incidence of otopathology or hearing loss.
  
  
  CONCLUSIONS
  Irrespective of the presence of any visible palatal abnormalities, children with congenital VPI showed a substantial incidence of otopathology and should thus be closely monitored.
authors.affiliation: Department of Otolaryngology, The Children's University Hospital, Dublin, Ireland. sheahanp@eircom.net
authors.forename: Patrick
authors.initials: P
authors.lastname: Sheahan
authors.forename: Ian
authors.initials: I
authors.lastname: Miller
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Jerome N
authors.initials: JN
authors.lastname: Sheahan
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Blayney
mesh_terms: D002648:Child; D005260:Female; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D008297:Male; D010033:Otitis Media / Q000209:etiology*; D010160:Palate, Soft / Q000473:pathology; D011795:Surveys and Questionnaires; D014681:Velopharyngeal Insufficiency / Q000150:complications* / Q000151:congenital*