Conservative management versus ventilation tube insertion in children with otitis media with effusion accompanying cleft palate

Abstract

Otitis media with effusion (OME) is a collection of non-purulent fluid in the middle ear space; it is almost universal in children with cleft palate. Cleft palate is among the most common congenital malformations, with an overall incidence of around 1 in 700 individuals (Flynn et al., 2009). Children with cleft palate are highly susceptible to OME because of abnormal insertion of the levator veli palatini and tensor veli palatini muscles on the Eustachian tube, resulting in poor active opening of the tube and developing OME (Dougherty and Kesser, 2015). Surgical closure of the cleft palate may lead to improvement in the audiological status of the patients, but whether early surgical correction can improve the middle ear status in CP children remains open for debate (Yang and McPherson, 2007). In fact, CP patient will develop particular problems because of the earlier age of onset, prolonged course, higher rate of recurrence, higher incidence of surgery and later complications, and potential diagnostic difficulties (NICE Clinical Guideline, 2008). OME can impair hearing at stages thought to be