(358) Outcomes After First Myringotomy Tube Insertion in Children with Cleft

Monday, October 2, 2023

2:45 PM – 3:45 PM East Coast USA Time

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Presenting Author(s)

Nick Sahlollbey, BHSc, MD (c)

Medical Student
University of Ottawa
Ottawa, Ontario, Canada

Senior Author(s)

JV

Jean-Philippe Vaccani, MD

Associate Professor and CHEO Chief, Department of Surgery and Division of Otolaryngolog HNS
Children's Hospital of Eastern Ontario, USA
CM

Claudia Malic, MD, MRCS (eng), FRCS (Plast)

Paediatric Plastic Surgeon and Associate Professor
Children's Hospital of Eastern Ontario
Ottawa, Ontario, Canada

Co-Author(s)

RW

Richard Webster, PHD, MSc

Children's Hospital of Eastern Ontario, USA
DR

Deepti Reddy, MS

Methodologist
Children's Hospital of Eastern Ontario
Ottawa, Ontario, Canada

Disclosure(s):

Nick Sahlollbey, BHSc, MD (c): No relevant relationships to disclose.

Claudia Malic, MD, MRCS (eng), FRCS (Plast): No relevant relationships to disclose.

Introduction: Management of auditory complications secondary to cleft pathologies consists of early myringotomy & tube insertion, often performed at the time of cleft palate repair. Our aim is to determine the effectiveness, the prevalence and predictor factors for complications associated with the first insertion of myringotomy tubes in children with OFC when compared with non-OFC patients.

Methods: This is a retrospective matched cohort 1:3 study using administrative data from CHEO Research Warehouse. The intervention group includes patients born with CP/CLP pathology (OFC cohort), had the cleft palate repair before 24 months of age and their 5th birthday was before 31/03/2020. The control group (non-OFC cohort) did not include any children with OFC and was matched based on gender and date of birth ± 30 days.

Results: The OFC cohort had 56 patients matched to 168 patients in the non-OFC cohort. In the OFC cohort, 73.2% had tube insertions at the time of cleft repair and 26.8% afterwards; 42 patients (75%) had at least another consequent surgery related to tube insertion with 39 patients having a total of 58 tube insertions (Range: 1-4). In the non-OFC group, 40% had consequent otologic surgery and 30% (51/168) had a total of 80 tube reinsertions (Range: 1-5). There was no difference in the incidence of otorrhea, tympanic membrane perforation, otalgia, cholesteatoma between the two cohorts. Median time to first tube reinsertion was 937 days in the OFC cohort and 720 days on the non-OFC cohort. The OFC cohort had more than twice the number of clinic follow up (p < 0.001), especially for patients who did not require further tube reinsertion or with more than 2 reinsertions. Recurrent OME after the first tube insertion was a predictive factor for future reinsertion.

Conclusions: Children with OFC pathologies have 2-fold increased risk of tube reinsertion after the initial insertion when compared to non-OFC cohort in the first 5 years of life and with more than twice the number of follow up appointments. Despite the higher number of tube insertions in the OFC group, they did not have a significantly higher number of complications related to the tubes.