title: Timing of Tympanostomy Tube Placement and Efficacy of Palatoplasty Technique on the Resolution of Chronic Otitis Media: A Cross-sectional Analysis.
abstract: BACKGROUND
  Chronic otitis media with effusion is a persistent complication essentially universal in children with cleft palate. The prevalence of chronic otitis media with effusion is hypothesized to be a result of Eustachian tube dysfunction secondary to the anomalous insertion of the palatal musculature. This study was designed to evaluate the timing of tympanostomy tube placement and the effect of primary palatoplasty technique on the recovery of Eustachian tube function and resolution of chronic otitis media with effusion.
  
  
  METHODS
  We performed a retrospective, cross-sectional analysis of the previous 99 consecutive patients who underwent a palatoplasty at our institution. Variables included timing of initial tympanostomy tube placement, palatoplasty technique, cleft type, and gender. These were then evaluated to assess their impact on the resolution of chronic otitis media with effusion. Resolution was established as an inverse function of the number of tympanostomy tubes placed in correlation with available audiometric/tympanographic data. For all models, a generalized linear mixed model was applied using a Poisson distribution and a log-link function where the outcome variable was the total number of tympanostomy tubes. For all tests, a P = .05 level of significance was used.
  
  
  RESULTS
  Of 99 palatoplasties performed, 94 patients were included in the study. Ninety-one percent of patients had documented chronic otitis media with effusion at the time of palatoplasty. Forty-four percent underwent straight-line repair with aggressive intravelar veloplasty, 36% had Furlow double z-plasty, 20% had straight-line repair without intravelar veloplasty. There was a statistically significant difference (F 2,83 = 5.36, P = .0065) between the 3 types of repair. The mean number of tubes placed was 0.6000 ± 0.1225, 0.8519 ± 0.1776, and 1.4737 ± 0.2785 for intravelar veloplasty, Furlow double z-plasty, and straight line without intravelar veloplasty, respectively . With regard to the timing of tympanostomy tube placement, there was a trend toward statistical significant (F 2,83 = 3.02, P = .0540) in the mean number of tube insertions was 1.4286 ± 0.4518, 0.6964 ± 0.1115, and 1.1304 ± 0.2217 when the initial set was placed before palatoplasty, at the time of palatoplasty, and after palatoplasty, respectively.
  
  
  CONCLUSIONS
  Despite its inherent limitations, this study suggests that palatal musculature reconstruction via intravelar veloplasty or reorientation via Furlow double z-plasty may improve Eustachian tube function and lower the need for tympanostomy tubes in this population. In comparison with other time points, patients who underwent initial tympanostomy tube placement at the time of palatoplasty trended toward improved chronic otitis media with effusion.
authors.affiliation: Virginia Commonwealth University, Richmond.
authors.forename: M S
authors.initials: MS
authors.lastname: Brgoch
authors.affiliation: Virginia Commonwealth University, Richmond.
authors.forename: K M
authors.initials: KM
authors.lastname: Dodson
authors.affiliation: Virginia Commonwealth University, Richmond.
authors.forename: T C
authors.initials: TC
authors.lastname: Kim
authors.affiliation: Virginia Commonwealth University, Richmond.
authors.forename: D M
authors.initials: DM
authors.lastname: Kim
authors.affiliation: Virginia Commonwealth University, Richmond.
authors.forename: R
authors.initials: R
authors.lastname: Trivelpiece
authors.affiliation: Virginia Commonwealth University, Richmond.
authors.forename: J L
authors.initials: JL
authors.lastname: Rhodes
keywords: Furlow double z-plasty; chronic otitis media; intravelar veloplasty; palatoplasty; tympanostomy tube