Hearing sensitivity in adults with a unilateral cleft lip and palate after two-stage palatoplasty.
OBJECTIVE
To evaluate long-term hearing and middle ear status in patients treated for a unilateral complete cleft lip and palate (UCLP) by two-stage palatoplasty.


METHODS
Forty-nine UCLP patients aged 17 years and older were included in this retrospective study. Patients were invited for a multidisciplinary long-term follow-up of their treatment at a tertiary center for craniofacial surgery in the Netherlands. ENT assessment included tympanometry and pure-tone audiometry. Medical files were searched for medical and surgical history.


RESULTS
In total, 19.4% of the patients had significant long-term hearing loss (PTA > 20 dB), comprising conductive hearing loss in 21.5% of the patients. In the majority (70%), this hearing loss was more pronounced at higher frequencies. In 25% the high fletcher index showed hearing thresholds above 20 dB. Ventilation tubes were placed at least once in 78.7% of the patients. The frequency of tube insertion was positively correlated with the incidence of reduced tympanic compliance (tympanogram type B) and the need for a pharyngoplasty.


CONCLUSIONS
The present study reports long-term hearing outcomes in UCLP patients with hard palate closure at 3 years of age. Persistent hearing loss was observed in 19.4% of our patients (PTA > 20 dB), mainly at the higher frequencies. Ventilation tube placement was associated with reduced tympanic compliance and higher risk on hearing loss (PTA air conduction). Our high incidence of velopharyngeal incompetence during early childhood, which is likely associated with Eustachian tube dysfunction, might have contributed to these results.
Department of Plastic Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands. Electronic address: isabellekappen@me.com.
I F P M
IF
Kappen
Department of ENT Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
J B S
JB
Schreinemakers
Department of ENT Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
K P Q
KP
Oomen
Department of Maxillofacial Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
D
D
Bittermann
Department of Plastic Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
M
M
Kon
Department of Plastic Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
C C
CC
Breugem
Department of Plastic Surgery, University Medical Centre Utrecht, P.O. Box 85090, 3508 AB, Utrecht, Utrecht, The Netherlands.
A B
AB
Mink van der Molen
D000158:Acoustic Impedance Tests; D000293:Adolescent; D000328:Adult; D001301:Audiometry, Pure-Tone; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D004432:Ear, Middle / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000453:epidemiology / Q000503:physiopathology; D006314:Hearing Loss, Conductive / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008876:Middle Ear Ventilation; D009426:Netherlands / Q000453:epidemiology; D021362:Palate, Hard / Q000601:surgery; D010160:Palate, Soft / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014681:Velopharyngeal Insufficiency / Q000453:epidemiology / Q000503:physiopathology*; D055815:Young Adult
Adult; Audiometry; Cleft lip; Cleft palate; Hearing loss; Tympanometry