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The Ears and Hearing in Children Born with Clefts

Children with cleft palates are at an increased risk of ear infections and forming fluid in their middle ears (middle ear effusion).  The muscles of the palate normally help open the eustachian tube—a tube that connects the middle ear to the throat.  In children with a cleft palate, the muscles of the palate are in the wrong location and therefore the eustachian tubes are not able to open up effectively, and air cannot enter the middle ear cavity.  When this happens, fluid builds up in the middle ear. 

This is a common occurrence in children born with cleft palates. This may result in frequent ear infections and puts the eardrum at risk of being permanently deformed, which can lead to hearing loss.  The hearing loss can also adversely affect speech development.  The ENT (Ear, Nose, and Throat) surgeon on the cleft team commonly performs a minor procedure called a myringotomy, where a slit is made in the ear drum to drain the fluid. A small tube is then placed in the slit to allow air into the middle ear and to prevent fluid from building up again.  This operation is usually performed under anesthesia at the same time as the lip or palate repair when possible.

Ear disease and hearing are monitored on a routine basis.  Hearing tests are performed by an audiologist.  One type of hearing screening test, called tympanometry, measures the response of the middle ear cavity to sound.  Another screening test, called otoacoustic emissions testing, or OAE for short, measures the response of the hearing nerve.  These tests may result in referral for additional testing.

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