Special Problems with the Ears
It is common for children with cleft palate to have associated problems with the middle ear. Most of these problems are caused by a malfunctioning of the Eustachian tubes which are small passages that lead from the middle ear to the throat. Their function is to allow pressure to equalize on the inside of the eardrum or tympanic membrane. They also serve to drain any fluid that may accumulate in the middle ear. Yawning allows air to pass through the Eustachian tubes to relieve pressure on the eardrum.
When the Eustachian tubes are not functioning properly, fluid can build up in the middle ear, causing discomfort and temporary or even permanent hearing loss. In the past, over fifty percent of adults and children with clefts had significant hearing loss. This, of course, has a direct correlation with speech development because children do not learn correct speech without proper hearing. Many parents with children who do not have clefts are familiar with Eustachian tube problems and treatment since it is a common complication of upper respiratory infections among young children. The problem is called otitis media or inflammation of the middle ear.
Treatment of Eustachian tube problems is by surgical placement of "ear tubes" called grommet tubes. These small plastic tubes are placed in the ear drum to allow normal ventilation and to drain fluid from the middle ear. With surgical treatment and continued regular assessment and care, hearing loss can be prevented.
An advantage of using the team approach to treat cleft patients is that the ear specialist, the otolaryngologist, can place the grommet tubes while cleft surgery is being performed. This may spare patients from an additional anesthesia and hospitalization.
As the child grows and his or her anatomy enlarges, middle ear problems may decrease. There is evidence that once the palate is closed surgically and the muscles are reconstructed, Eustachian tube problems are alleviated or improved. However, a few children require repeated grommet tube replacement over a period of years to prevent unnecessary hearing loss. These children should be assessed by an otolaryngologist every three months until they are free of symptoms. Your pediatrician can help monitor this.