Does Type of Cleft Palate Repair Influence Postoperative Eustachian Tube Dysfunction?
OBJECTIVE
Otitis media (OM) is a frequent occurrence in the cleft palate population. Palate repair is thought to positively contribute to Eustachian tube function. The purpose of this study is to determine the proportion of cleft patients in our cohort with OM, and if palatoplasty closure technique influences future OM differently. The authors posited that Z-plasty palate repair would result in improved Eustachian tube function, compared with straight-line repair.


METHODS
Patient records were accessed and data was recorded on palatoplasties from 2005 to 2007 as well as from 2012 to 2014. Type of palatoplasty (straight-line vs. Z-plasty) was recorded and compared to prevalence of pressure equalizer tube placement and antibiotic prescriptions in various assessment intervals following repair 1) <6 months, 2) 6 months to 1 year. Statistical analysis included Welch 2 sample t test.


RESULTS
The type of cleft palate was similar between the 2 groups. Prior to palate repair, over 30% of subjects in both groups required either tubes or antibiotics for OME. At the time of surgery, over 50% of patients received ear tubes, in both groups. Following repair, for straight versus Z, 0 versus 11%; and, 27.8 versus 20% required ear tubes for intervals 1) and 2), respectively. P values for both intervals are 0.9183 and 0.328, respectively. Antibiotics during interval one were required in 22.2% versus 23.5% of straight-line closures and Z-plasty, respectively. Antibiotics in the second interval were needed for 33.3% and 30% of straight-line closures and Z-plasty closures, respectively. P values for antibiotic use in the first and second intervals were 0.5353 and 0.4316 respectively.


CONCLUSIONS
Cleft palate patients have a high prevalence of OM. Palatoplasty technique (straight-line and Z-plasty) does not affect Eustachian tube dysfunction differently following repair as measured by pressure equalizer tube placement and antibiotic use.
*Yale University †Connecticut Pediatric Otolaryngology, New Haven, CT.
Alexander T
AT
Wilson
Graham M
GM
Grabowski
Wendy S L
WS
Mackey
Derek M
DM
Steinbacher
D002972:Cleft Palate / Q000601:surgery*; D005064:Eustachian Tube / Q000503:physiopathology*; D006801:Humans; D010033:Otitis Media / Q000209:etiology / Q000503:physiopathology*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000009:adverse effects*