Karen Appold is a medical writer in Pennsylvania.
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May 2021Addressing Hearing Loss Caused by Craniofacial Clefts
Craniofacial clefts, specifically cleft palates, are strongly associated with recurrent otitis media with effusion and hearing loss. The higher incidence of otitis media with effusion in this population can be due to mechanical issues such as Eustachian tube dysfunction, infection between the mouth and nasopharynx, and dynamic factors related to Eustachian tube and middle ear function, said Allison McGrath, AuD, CCC-A, clinical audiologist and assistant of otolaryngology, division of audiology, department of otolaryngology–head and neck surgery at Johns Hopkins Medicine in Baltimore.
Close interprofessional management is necessary to manage these patients’ specific and complex needs to avoid long-term issues, Dr. McGrath said. Multiple studies estimate that at least 90% of cleft palate patients have otitis media at some point during their childhood (Arch Dis Child. 1988; 63:176-179; HNO. 1994;42:691-696). “Monitoring middle ear disorders in this population is imperative to managing associated hearing loss and its possible impact on speech and language development,” she said.
Many children with cleft palates require the placement of ventilation tubes within the first year of life, with a large number placed at the time of their cleft palate repair, Dr. McGrath said. Some children go on to receive multiple sets of tubes, which puts them at a higher risk for tympanosclerosis, cholesteatomas, tympanic membrane perforations, and permanent conductive hearing loss (Indian J Plast Surg. 2009;42:S144-S148; Cleft Palate-Craniofacial J. 2017;54:650-655).
Craniofacial cleft patients need to be recognized early and managed in a specialized multidisciplinary team comprising plastic surgeons, otolaryngologists, sleep physicians, orthodontists and dentists, speech and language pathologists, social workers, and geneticists, said Ana H. Kim, MD, associate director of the residency program and an associate professor of otolaryngology–head and neck surgery at Columbia University Medical Center, New York City.
Central to improving communication is early assessment and intervention by speech and language pathologists specializing in patients with craniofacial clefts. These experts help establish correct articulation using various strategies. Otologists play a central role in addressing hearing loss in these patients, providing education about treatment options, and connecting them to proper referrals, Dr. Kim said.