Hearing and Otologic Outcomes After Routine Versus Selective Ventilation Tube Insertions in Children With Cleft Palate: A Retrospective Cohort Study

ObjectiveThis study compares audiologic and otologic outcomes of routine and selective ventilation tube insertion (VTI) performed during palatoplasty.DesignRetrospective cohort.SettingCleft Team North, location Leeuwarden, Oral Clefts Referral Center.Patients, ParticipantsChildren with cleft palate, with or without cleft lip and/or alveolar involvement (CP ± L).InterventionsVTI was performed concurrently with palatoplasty at 9-10 months of age. Until 2019, VTI was routinely performed. Under the new protocol introduced thereafter, VTI is only performed at the time of palatoplasty if previously indicated based on audiologic and ear, nose, and throat (ENT) evaluation conducted at 8 months of age.Main Outcome Measure(s)Data were collected from medical records and included audiologic and ENT assessments before and after VTI, frequency of otorrhea, re-tympanostomy, and otologic complications such as persistent perforation, cholesteatoma, and tympanosclerosis. A uniform follow-up period of 2 years was implemented for all participants in both groups to enable a consistent comparison over time.ResultsForty-one children with CP ± L were included: 21 received VTI during palatoplasty under the routine protocol, and 20 were managed under the selective protocol. Of the latter, 17 were indicated for VTI at the time of surgery, while 2 of the 3 initially not indicated required VTI during follow-up. No significant differences were observed between groups in re-tympanostomy rates, hearing outcomes, or surgical complications.ConclusionsRoutine VTI appears to be necessary in children with CP ± L. Furthermore, ENT clinical examination alone may suffice for VTI indication, reducing unnecessary audiologic assessments and therefore lowering the burden of care without compromising quality of care.