Early Eustachian Tube Dysfunction and Velopharyngeal Competence in Children with Cleft Palate

Introduction: Children with cleft palate often demonstrate early eustachian tube dysfunction (ETD) and associated hearing loss during infancy. Currently, the impact of early ETD is unknown on future speech and language development. The goal of this study is to assess the cleft related co-morbidities associated with early ETD.

Methods: A retrospective chart review was performed (March 2001 to September 2024) at a tertiary academic medical center with a long-standing, multi-disciplinary cleft team. Pertinent information collected included demographics, audiograms, surgical history, and speech language pathology evaluation (clinical evaluation, flexible nasopharyngoscopy, nasometry, and/or videofluoroscopy). Early ETD was defined as the need for tympanostomy tubes before 12 months of age, and velopharyngeal incompetence was determined by the need for corrective surgery. Data analysis was performed using R Studio (RStudio Team, 2024) to conduct Fischer’s exact and Pearson’s chi-squared test for categorical variables and Wilcoxon rank sum test for continuous variables (significance p < 0.05).

Results: Forty-three children were included, having a median follow-up length of 9.45 years in our multi-disciplinary cleft clinic. Twenty-six out of 43 (60.5%) children had early ETD. These children were significantly more likely to have a comorbid cleft lip and higher Veau/Iowa cleft classification (p < 0.001). Children with early ETD were significantly more likely to require more total sets of tubes (p = 0.002). This same cohort was significantly more likely to require surgery for velopharyngeal incompetence (p= 0.039) and demonstrated decreased median lateral wall movement, 15% compared to 18%, but this was not statistically significant (>0.9).

Conclusions: Children with early ETD are high-risk for cleft related co-morbidities, including the need for statistically more sets of ear tubes. These children with early ETD intervention are also more likely to need surgical correction of velopharyngeal incompetence. Further work is needed to understand the relationship between early ETD and velopharyngeal incompetence.