title: Grommets and speech at three and six years in children born with total cleft or cleft palate.
abstract: OBJECTIVE
  Grommets may be considered as the treatment of choice for otitis media with effusion (OME) in children born with a cleft. But the timing and precise indications to use them are not well established. The aim of the study is to compare the results of hearing and speech controls at three and six year-old in children born with total cleft or cleft palate in the presence or not of grommets.
  
  
  METHODS
  This retrospective study concerns non syndromic children born between 1994 and 2006 and operated for a unilateral cleft lip palate (UCLP) or a cleft palate (CP) alone, by one surgeon with the same schedule of operations (Malek procedure). We compared the results of clinical observation, tympanometry, audiometry and nasometry at three and six year-old. The Borel-Maisonny classification was used to evaluate the velar insufficiency. None of the children had preventive grommets. The Fisher Exact Test was used for statistical analysis with p<0.05 considered as significant.
  
  
  RESULTS
  Seventy-seven patients were analyzed in both groups. Abnormal hearing status was statistically more frequent in children with UCLP compared to children with CP, at three and six years (respectively, 80-64%, p<0.03 and 78-60%, p<0.02), with the use of grommets at six years in 43% of cases in both groups. Improvement of hearing status between three and six year-old was present in 5% of children with UCLP and 9% with CP, without the use of grommets.
  
  
  CONCLUSIONS
  The use of grommets between three and six year-old was not associated to any improvement of hearing status or speech results children with UCLP or with CP, with a low risk of tympanosclerosis. These results favor the use of grommets before the age of three, taking into account the risk of long term tympanosclerosis.
authors.affiliation: Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
authors.forename: Oumama El
authors.initials: OE
authors.lastname: Ezzi
authors.affiliation: Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
authors.forename: Georges
authors.initials: G
authors.lastname: Herzog
authors.affiliation: Department of Otolaryngology, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Broome
authors.affiliation: Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
authors.forename: Chantal
authors.initials: C
authors.lastname: Trichet-Zbinden
authors.affiliation: Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
authors.forename: Judith
authors.initials: J
authors.lastname: Hohlfeld
authors.affiliation: Department of Otolaryngology, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cherpillod
authors.affiliation: Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland. Electronic address: anthony.debuys-roessingh@chuv.ch.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: de Buys Roessingh
mesh_terms: D001299:Audiometry; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000150:complications* / Q000601:surgery; D002972:Cleft Palate / Q000150:complications* / Q000601:surgery; D005260:Female; D006309:Hearing; D006311:Hearing Disorders / Q000209:etiology; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000295:instrumentation; D010034:Otitis Media with Effusion / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013060:Speech; D013064:Speech Disorders / Q000209:etiology; D014681:Velopharyngeal Insufficiency / Q000209:etiology
keywords: Cleft; Grommets; Hearing; Speech; Timing