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Cleft Palate and Eustachian Tube Dysfunction

The Ear, Nose, and Throat (ENT) physician is part of the Cleft and Craniofacial Team at Riley at IU Health. In this blog entry, Dr. Stuart Morgenstein discusses the incidence and treatment of middle ear disorder in children with cleft palate.

Children with cleft palates often have problems with their Eustachian tubes which can result in collection of fluid in the middle ear (the space behind the eardrum). This fluid collection can result in hearing loss.

The Eustachian tube has a bony and cartilaginous structure. It opens into the back of the nose. It functions to 1) regulate the pressure of the middle ear 2) protect the middle ear from reflux of secretions from the back of the nose 3) drain the middle ear secretions into the back of the nose.

Three small muscles assist in opening and closing the tube. Yawning and swallowing (such as sucking on a bottle) will open the tube. The cleft palate can result in defective functions of these muscles. The Eustachian tube can also adversely be affected by allergies, gastroesophageal reflux (GERD), and colds.

Hearing tests are often obtained in children with cleft palates. This includes tympanometry which measure the mobility of the eardrum. Reduced mobility (“flat”) tympanograms suggests fluid. The fluid collection can result in a conductive hearing loss. This is when sound has reduced ability to go from the outside environment into the middle ear to the cochlea (the “organ of hearing”).

The primary treatment is placement of “PE” tubes (pressure equalization tubes) into the eardrum via the ear canal to drain the fluid and help the eardrum “breathe”/drain better. This procedure takes about five minutes and is often performed in conjunction with cleft palate repair.

Most tubes stay in about 6-12 months on average. Sometimes they have to be replaced several times. Most children will outgrow the need for tubes by about age eight.

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