title: Retrospective analysis of tympanoplasty in children with cleft palate: a 24-year experience. II. Cholesteatomatous cases.
abstract: BACKGROUND
  Contradictory experience has been published on the outcomes of ear surgery in patients with cleft palate.
  
  
  OBJECTIVE
  The authors of this study investigated whether there were differences in the short- and long-term outcomes of tympanoplasty performed due to cholesteatoma in children with or without cleft palate.
  
  
  METHODS
  Tertiary care medical centre.
  
  
  METHODS
  The authors retrospectively analyzed the first author's 24-year experience of paediatric tympanoplasty using the software programme developed by the fourth author. The outcomes of 268 tympanoplasties on 172 ears with cholesteatoma in 151 'NoCleft' patients were compared to the outcomes of 35 tympanoplasties on 20 ears of 19 'Cleft' patients. The average age of the patients was 10.7±3.6 years and 9.5±2.7 years respectively. The average follow-up time was 4 and 4.1 years.
  
  
  RESULTS
  Preoperative PTA-ABGs (31.22/34.88 dB; p=0.058), best postoperative PTA-ABGs (17.04/16.4 dB; p=0.499), last postoperative PTA-ABGs (19.93/20.98 dB; p=0.298), the final hearing improvement (11.29/13.9 dB; p=0.193) and postoperative PTA-ABG deterioration with time (2.89/4.58 dB; p=0.117) were statistically compared between the 'NoCleft' and 'Cleft' groups. The same parameters were analyzed separately in the case of tympanoplasty performed with intact ossicular chain and the different type of columella ossiculoplasty. No significant differences were found between the two groups in any of these parameters. However, significant difference was found in the necessity for grommet insertion (8-fold difference, p≈0), and conversion to open techniques (p≈0).
  
  
  CONCLUSIONS
  The authors conclude that the achievable audiological outcomes of tympanoplasty in children with cleft palate and cholesteatoma do not differ significantly from those of the general child population. However, this more frequently requires ventilation tube insertion and more frequent follow-up visits. The latter is ensured by patient care within the frameworks of the 'Cleft Palate Team'. We have to accept that in some cases Eustachian tube dysfunction caused by the underlying disease (cleft palate) 'takes over' and we have to resort to open techniques.
authors.affiliation: Department of Pediatrics, University of Pécs Medical School, Pécs, Hungary. Electronic address: kopcsanyi.gabor@pte.hu.
authors.forename: Gábor
authors.initials: G
authors.lastname: Kopcsányi
authors.affiliation: Department of Pediatrics, University of Pécs Medical School, Pécs, Hungary.
authors.forename: Olga
authors.initials: O
authors.lastname: Vincze
authors.affiliation: Pollack Mihaly Faculty of Engineering and Information Technology, University of Pécs, Hungary.
authors.forename: Viktor
authors.initials: V
authors.lastname: Bagdán
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Pécs Medical School, Pécs, Hungary.
authors.forename: József
authors.initials: J
authors.lastname: Pytel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018424:Cholesteatoma, Middle Ear / Q000150:complications / Q000601:surgery*; D002972:Cleft Palate / Q000150:complications* / Q000601:surgery; D004429:Ear Ossicles / Q000601:surgery; D005260:Female; D006309:Hearing; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014433:Tympanoplasty; D055815:Young Adult
keywords: Cholesteatoma; Cleft palate; Paediatric tympanoplasty; Short and long term follow-up