Audiology, otology, and airway

Appropriate treatment of children with palatal and facial clefts is multifactorial. It should include an evaluation of hearing with possible subsequent management of hearing loss. Children with a cleft palate are at increased risk of eustachian tube dysfunction, persistent middle ear effusion, and chronic hearing loss. Over many years after cleft palate repair, eustachian tube dysfunction improves but often not before speech and language development has been stunted. An otoscopic exam by an otolaryngologist combined with acoustic immittance testing can reliably and feasibly diagnose middle ear dysfunction in children and guide surgical interventions. Myringotomy with tympanostomy tube placement is the accepted treatment for eustachian tube dysfunction in children, as it has been demonstrated to relieve middle ear effusion and improve hearing loss. This chapter describes variations in anatomy of the eustachian tube and middle ear in patients with a cleft palate, details necessary aspects of audiologic testing for this population, and illustrates the procedure of myringotomy with tympanostomy tube placement. Additionally, children with cleft palate can also have syndromes which predispose them to having difficulty with their airway. It is imperative to understand these airway concerns and possible interventional strategies to prevent morbidity and mortality.