Eplasty. 2015 Jul 27;15:e32. eCollection 2015.
Timing of Tympanostomy Tube Placement and Efficacy of Palatoplasty Technique on the Resolution of Chronic Otitis Media: A Cross-sectional Analysis.
Eplasty
M S Brgoch, K M Dodson, T C Kim, D M Kim, R Trivelpiece, J L Rhodes
Affiliations
Affiliations
- Virginia Commonwealth University, Richmond.
PMID: 26240670
PMCID: PMC4520385
Abstract
BACKGROUND: Chronic otitis media with effusion is a persistent complication essentially universal in children with cleft palate. The prevalence of chronic otitis media with effusion is hypothesized to be a result of Eustachian tube dysfunction secondary to the anomalous insertion of the palatal musculature. This study was designed to evaluate the timing of tympanostomy tube placement and the effect of primary palatoplasty technique on the recovery of Eustachian tube function and resolution of chronic otitis media with effusion.
METHODS: We performed a retrospective, cross-sectional analysis of the previous 99 consecutive patients who underwent a palatoplasty at our institution. Variables included timing of initial tympanostomy tube placement, palatoplasty technique, cleft type, and gender. These were then evaluated to assess their impact on the resolution of chronic otitis media with effusion. Resolution was established as an inverse function of the number of tympanostomy tubes placed in correlation with available audiometric/tympanographic data. For all models, a generalized linear mixed model was applied using a Poisson distribution and a log-link function where the outcome variable was the total number of tympanostomy tubes. For all tests, a P = .05 level of significance was used.
RESULTS: Of 99 palatoplasties performed, 94 patients were included in the study. Ninety-one percent of patients had documented chronic otitis media with effusion at the time of palatoplasty. Forty-four percent underwent straight-line repair with aggressive intravelar veloplasty, 36% had Furlow double z-plasty, 20% had straight-line repair without intravelar veloplasty. There was a statistically significant difference (F 2,83 = 5.36, P = .0065) between the 3 types of repair. The mean number of tubes placed was 0.6000 ± 0.1225, 0.8519 ± 0.1776, and 1.4737 ± 0.2785 for intravelar veloplasty, Furlow double z-plasty, and straight line without intravelar veloplasty, respectively . With regard to the timing of tympanostomy tube placement, there was a trend toward statistical significant (F 2,83 = 3.02, P = .0540) in the mean number of tube insertions was 1.4286 ± 0.4518, 0.6964 ± 0.1115, and 1.1304 ± 0.2217 when the initial set was placed before palatoplasty, at the time of palatoplasty, and after palatoplasty, respectively.
CONCLUSIONS: Despite its inherent limitations, this study suggests that palatal musculature reconstruction via intravelar veloplasty or reorientation via Furlow double z-plasty may improve Eustachian tube function and lower the need for tympanostomy tubes in this population. In comparison with other time points, patients who underwent initial tympanostomy tube placement at the time of palatoplasty trended toward improved chronic otitis media with effusion.
Keywords: Furlow double z-plasty; chronic otitis media; intravelar veloplasty; palatoplasty; tympanostomy tube
References
- Arch Otolaryngol Head Neck Surg. 2009 Aug;135(8):748-51 - PubMed
- Laryngoscope. 1985 Sep;95(9 Pt 1):1044-6 - PubMed
- J R Soc Med. 1988 Dec;81(12):710-3 - PubMed
- Plast Reconstr Surg. 2002 Aug;110(2):409-14; discussion 415-6 - PubMed
- J Craniomaxillofac Surg. 2003 Oct;31(5):316-20 - PubMed
- Ann Otol Rhinol Laryngol. 1991 Nov;100(11):909-13 - PubMed
- Cleft Palate J. 1986 Jan;23(1):63-8 - PubMed
- Cleft Palate Craniofac J. 2009 Jan;46(1):30-8 - PubMed
- Ann Otol Rhinol Laryngol. 1991 Jun;100(6):439-46 - PubMed
- Ann Otol Rhinol Laryngol. 1971 Aug;80:Suppl 2:1-30 - PubMed
- Laryngoscope. 1995 Sep;105(9 Pt 1):905-8 - PubMed
- Cleft Palate Craniofac J. 2011 Jul;48(4):412-8 - PubMed
- Arch Otolaryngol Head Neck Surg. 2008 Oct;134(10):1085-9 - PubMed
- Birth Defects Res A Clin Mol Teratol. 2010 Dec;88(12):1008-16 - PubMed
- Plast Reconstr Surg. 2007 May;119(6):1859-65 - PubMed
- Otolaryngol Head Neck Surg. 1994 Oct;111(4):423-9 - PubMed
- Plast Reconstr Surg. 2008 Oct;122(4):1121-30 - PubMed
- Zhonghua Er Bi Yan Hou Ke Za Zhi. 2004 Apr;39(4):216-8 - PubMed
- Cleft Palate Craniofac J. 2012 Jul;49(4):504-7 - PubMed
- Clin Otolaryngol Allied Sci. 2002 Dec;27(6):494-500 - PubMed
- Plast Reconstr Surg. 1997 Sep;100(4):833-42 - PubMed
- J Laryngol Otol. 1992 Sep;106(9):788-92 - PubMed
- Ann Otol Rhinol Laryngol Suppl. 1980 May-Jun;89(3 Pt 2):34-40 - PubMed
- Pediatrics. 1969 Jul;44(1):35-42 - PubMed
- Birth Defects Res A Clin Mol Teratol. 2006 Nov;76(11):747-56 - PubMed
- Int J Pediatr Otorhinolaryngol. 2009 Feb;73(2):307-13 - PubMed
- Cleft Palate Craniofac J. 1998 Nov;35(6):495-9 - PubMed
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