(499) Timing of Initial Tympanostomy Tubes in Children with Cleft Palate

Introduction: Tympanostomy tube (TT) placement is performed on patients with cleft palate to reduce sequelae from chronic otitis media. Initial tube placement can be done before, concurrent with, or after palatoplasty with evidence that earlier TT placement increases risk of otorrhea. Our objective is to assess differences in complications of children with early vs late TT placement.

Methods: A retrospective review was conducted of 87 patients born with cleft palate in 2013-2015 and had TT placed at Children’s Hospital of Wisconsin. These patients were split into two groups: those with initial TT placed before palatoplasty (Group 1) and those with initial TT placed simultaneously/after palatoplasty (Group 2). We reviewed post-operative symptoms (by parent report) and physical exam findings to compare middle ear health between groups. We also examined the lifetime total number of TT placed as a long-term outcome. Odds ratios (OR), 95% confidence intervals (CI), and p-values (p) were calculated.

Results: There were 87 children in the study: 62 in Group 1 and 25 in Group 2. Group 1 children had higher incidence of parent-reported problems post-operatively (OR=5.08, p=0.039) as well as a higher incidence of at least 1 unhealthy ear on post-op examination (OR=6.78, p=0.015). Group 1 also had more total tubes placed throughout their childhood (3.51) compared with Group 2 (2.52) (p=0.002).

Conclusions: Placing TT before palatoplasty resulted in higher odds of having post-op ear or TT problems and more TT placed in childhood when compared to placement at or after the time of palatoplasty. A larger sample size with multiple longitudinal outcomes, including speech, hearing, and educational data, is necessary to determine which practice is most beneficial for this population.