Text supplied by Lesley Salkeld, Otolaryngology (ENT) Surgeon Starship Hospital and Anthony Cecire, Otolaryngology (ENT) Surgeon, Waikato Hospital.
Children with cleft palate have a higher chance of having ear problems. This is because the small tube between the throat and ears does not open and close properly. This tube is called the Eustachian Tube. It lets air into a small space called the Middle Ear, which is behind the eardrum (or Tympanic Membrane). The Eustachian tube is opened and closed by small muscles in the throat which connect to the palate.
Sometimes because of the defect in cleft palate, the small muscles in the throat are unable to open and close the Eustachian tube properly. As a result fluid present in the middle ear before birth may not drain out of the middle ear. This fluid can become a thick mucus-like fluid (sometimes called “glue ear” or otitis media with effusion, OME). The thickened fluid can block the transfer of sound by stopping the vibration of the ear drum and the 3 tiny bones inside the middle ear.
Acute ear Infection
Additionally the difficulty with eustachian tube ventilation may increase the chance of acute ear infection. This is a short-term illness where the middle ear space fills with infected pus (usually containing bacteria) and may cause the ear drum to bulge out then rupture. The signs of acute ear infection are pain in the ear with upset and possible fever. Young children may appear irritable and have disturbed sleep. Acute ear infection may develop after a cold or flu- the treatment is medication to relieve pain (usually Paracetamol) and antibiotics.
The signs of glue ear are more gradual and may linger for months or years if untreated. The thick fluid causes conductive hearing loss which is a mild to moderate deafness. Some children will complain that their ears seem blocked and may have poor balance. This deafness will affect the ability to hear conversational speech, especially when background noise is present. If left untreated for many months, the condition will hinder the development of pronunciation and speech.
Chronic Glue Ear
The treatment for chronic glue ear is to insert a tiny ventilating tube (called a grommet) into the ear drum. This is a minor surgical operation, which takes a few minutes and requires general anaesthetic in young children. After the operation the hearing should return to normal. Grommets also reduce the chance of acute ear infection and gradually grow out of the ear drums after about 6-18 months.
Fortunately, ear problems tend to become less as children grow. Previously many cleft palate patients would develop permanent hearing loss, but this seldom happens with current treatment, and children with cleft lip have no more ear problems than the average population.
Audiology (hearing testing) is very helpful in detecting when glue ear or other hearing problems are present. Testing can be performed in very young children, even babies. It is especially important to have testing if there is concern that babies or children do not react to sounds, do not seem to hear conversational speech or have delayed speech development. Audiology may include testing for ear drum vibration, testing for reaction to sound or using computer technology to test the responses of the inner ear.
Tonsils & Adenoids
Other ear, nose or throat problems in cleft palate patients may include infection or enlargement of the tonsils and adenoids. Some patients may require removal of their tonsils if frequent sore throats due to tonsillitis occur. Surgery may also be needed if excessive enlargement causes obstruction in the throat.
The adenoids (which are a growth of tissue at the junction of the throat and back of nose), usually are helpful to cleft palate patients to reduce the escape of air into the nose during speech. It is recommended that cleft palate patients do not have their adenoids removed, except in very rare circumstances. Any recommendation for tonsil or adenoid surgery should be discussed with cleft palate team members.
Other conditions: Patients with cleft lip and palate may have associated deviation of nasal cartilages, which could affect breathing and make other common nasal problems such as allergy or sinusitis more evident.
Babies who have cleft palate associated with other congenital conditions or syndromes may have abnormalities of the throat, voice box (larynx) or windpipe (trachea). Occasionally examination or treatment of these other areas may be required.
Treatment of ear, nose and throat disorders is undertaken by an Otolaryngologist (Ear, Nose and Throat Surgeon). It is desirable that treatment decisions are made with other healthcare professionals who are working together to co-ordinate the treatment programme.