RECOVERY OF EUSTACHIAN-TUBE FUNCTION AND HEARING OUTCOME IN PATIENTS WITH CLEFT-PALATE

Eustachian tube dysfunction is a nearly universal complication of clef t palate, resulting in chronic ear disease and conductive hearing loss . Cleft palate repair is thought to result in recovery of eustachian t ube function, but the length of time between repair and recovery of eu stachian tube function is not known. Furthermore, the efficacy of tymp anostomy tubes in the treatment of eustachian tube dysfunction and hea ring sequelae has not been examined in a systematic way. To answer the se questions, we performed a retrospective study that used serial audi ometric data and tympanometry on 81 patients with cleft palates (162 e ars), with follow-up ranging from 1 to 17.3 years. Average time to rec overy of eustachian tube function was 6.0 years (range, 1.0 fo 10.3 ye ars) after cleft palate surgery. For children followed up for at least 6 years (longest follow-up, 17.3 years), 70% (67 of 85) had normal eu stachian tube function at their last follow-up visit. Ears treated wit h Armstrong tympanostomy tubes required an average of 3.1 tubes per ea r until recovery of eustachian tube function, whereas ears treated wit h Goode T tubes required only 1.1 tubes per ear (p < 0.05). Hearing ev aluation revealed that 67% of ears had abnormal hearing thresholds (>2 0 dB) before tympanostomy tube placement, whereas only 7.5% of ears de monstrated this loss after tube placement. Furthermore, more than 90% of ears maintained normal thresholds after recovery of eustachian tube function. These data indicate that most children with cleft palates e ventually recover normal eustachian tube function after palatoplasty, but for the majority of children, this does not occur for many years. Furthermore, the hearing loss before tympanostomy tube placement and p alatoplasty largely resolves after aeration of the middle ear and does not result in any significant permanent hearing deficit.