The impact of hearing loss on speech outcomes in 5-year-old children with cleft palate ± lip: A longitudinal cohort study.

OBJECTIVES: To investigate the impact of hearing loss (using longitudinal measurements of hearing) on speech outcomes at age 5 (5 years 0 months-5 years 11 months) in children born with cleft palate ± lip. Other variables which may impact upon the speech outcomes at age 5 in this population were also investigated. METHODS: A retrospective longitudinal cohort study of children, without a named syndrome, born with cleft palate ± lip, and treated at a Cleft Centre in the United Kingdom. Data collected from infancy to 5 years 11 months, included hearing test results from three specific time points (7 months-1 year 2 months [age A]; 2 years 0 months-2 years 11 months [age B]; 5 years 0 months-5 years 11 months [age C]) and speech outcome data at age 5 years (5 years 0 months-5 years 11 months). Hearing test results at each age were compared to identify how hearing changes with age. Correlations between hearing test results and speech outcomes at age 5 were analysed. RESULTS: Hearing loss was frequent but predominantly mild. There were no significant correlations between speech outcomes and hearing results at any age. Mild hearing loss remained prevalent at age 5, although a significant age-related hearing improvement was found. A significant relationship between cleft type and cleft speech characteristics was found (P < .001); children with Bilateral Cleft Lip and Palate achieved the poorest articulation outcomes. CONCLUSION: Although mild hearing loss was common in the cohort, there was no association between hearing loss and the speech outcomes investigated. In contrast, the type of cleft was significantly associated with the presence of cleft speech characteristics. Further longitudinal measurement of hearing is required to substantiate the findings of this study.

Grommet Surgery in Children With Orofacial Clefts in England.

OBJECTIVE: To assess grommet insertion practice in the first 5 years of life among children with an orofacial cleft in England. DESIGN: Analysis of national administrative data of hospital admissions. SETTING: National Health Service hospitals, England. PATIENTS: Patients born between 1997 and 2005 who underwent surgical cleft repair. INTERVENTION: Children receiving grommets before the age of 5 years. OUTCOME MEASURES: The proportion of children receiving grommets before the age of 5 years, the timing of the first grommet insertion, and the proportion of children having repeat grommet insertions were examined according to cleft type, the absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. RESULTS: The study included 8,269 children. Before the age of 5 years, 3,015 (36.5%) children received grommets. Of these, 33.2% received their first grommets at primary cleft repair and 33.3% underwent multiple grommet insertion procedures. The most common age for the first procedure was between 6 and 12 months. Children with a cleft affecting the palate were more likely to receive grommets than children with a cleft lip alone (45.5% versus 4.5%). Grommet insertion practice also varied according to year of birth, absence or presence of additional anomalies, socioeconomic deprivation, and region of residence. CONCLUSION: Grommets practice in children with a cleft appears to vary according to their clinical characteristics. The differences in practice observed according to deprivation and region of residence need to be further explored.

Pediatric myringoplasty: definition of "success" and factors affecting outcome.

INTRODUCTION: Recent studies have reported a high success rate of pediatric myringoplasty, but their definition of success and length of follow-up vary widely. Authors debate whether the success of a pediatric myringoplasty should be defined purely by an intact tympanic membrane or should analysis of middle ear health and audiometric data also be included. For the purposes of this study, success was defined as an intact tympanic membrane at 12 months postsurgery without evidence of effusion and preservation of hearing. OBJECTIVES: To determine the true success rate of myringoplasty and identify any independent factors that significantly influence outcome. MATERIALS AND METHODS: This was a retrospective analysis of 132 myringoplasties performed at Birmingham Children's Hospital. Cases were grouped into those children aged younger than 8 years and those aged 8 years and older. RESULTS: An intact tympanic membrane was present in 80.0% of cases at the first postoperative visit. However, at 12 months, the previously defined success rate, cases decreased to 67.3%. Younger age (p < 0.0047) and anterior perforations (p <0.0038) were the only factors found to be associated with a poorer outcome. CONCLUSION: The true rate of success of a pediatric myringoplasty would seem to be lower than rates commonly quoted to parents, and this finding is in keeping with other otologists using a similar definition of success. Younger age at the time of surgery and anterior perforations have a less successful outcome. These findings are important when counseling/consenting carers of younger children about to undergo a myringoplasty.