Otologic and audiologic outcomes with the Furlow and von Langenbeck with intravelar veloplasty palatoplasties in unilateral cleft lip and palate.
OBJECTIVE
Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age.


METHODS
Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair.


METHODS
Centralized, tertiary care craniofacial treatment center.


METHODS
A total of 673 infants with unilateral cleft lip and palate.


METHODS
Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed.


METHODS
Hearing and otoscopic findings at 5 to 6 years old.


RESULTS
There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio  =  5.1, 95% confidence interval  =  1.44 to 18.11, p  =  .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations.


CONCLUSIONS
Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation.
Antonelli
Patrick J
PJ
Jorge
José C
JC
Feniman
Mariza R
MR
Piazentin-Penna
Sílvia H A
SH
Dutka-Souza
Jeniffer C R
JC
Seagle
M Brent
MB
Williams
William N
WN
Nackashi
John A
JA
Boggs
Steve
S
Graciano
Maria I G
MI
Souza
Telma V
TV
Neto
José S M
JS
Garla
Luis A
LA
Silva
Marcos L N
ML
Marques
Ilza L
IL
Borgo
Hilton C
HC
Martinelli
Angela P M C
AP
Shuster
Jonathan J
JJ
Pimentel
Maria C M
MC
Zimmermann
Maria C
MC
Bento-Gonçalves
Cristina G A
CG
Kemker
F Joseph
FJ
McGorray
Susan P
SP
Pegoraro-Krook
Maria I
MI
D000158:Acoustic Impedance Tests / Q000379:methods; D000367:Age Factors; D001301:Audiometry, Pure-Tone / Q000379:methods; D018424:Cholesteatoma, Middle Ear / Q000209:etiology; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D004311:Double-Blind Method; D004427:Ear Diseases / Q000209:etiology*; D004432:Ear, Middle / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000209:etiology*; D006314:Hearing Loss, Conductive / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000209:etiology; D038781:Otoscopy / Q000379:methods; D010160:Palate, Soft / Q000601:surgery; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D018058:Tympanic Membrane Perforation / Q000209:etiology