1
|
Fatima K, Chaudhari PK, Duggal R, Kharbanda OP, Thakar A. Effects of RME on Hearing in UCLP Patients: A Pilot Study. Cleft Palate Craniofac J 2023; 60:1442-1449. [PMID: 35675169 DOI: 10.1177/10556656221104945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the changes in hearing after rapid maxillary expansion (RME) and at the end of 6 months retention period in complete unilateral cleft lip and palate (UCLP) patients using pure tone audiometry and tympanometry test. DESIGN Prospective pilot study. SETTING Tertiary health care teaching hospital in New Delhi. PATIENTS This study was conducted on 6 UCLP patients in the age range of 6-14 years with normal ear anatomy. All 6 patients had undergone primary repair of cleft lip and palate and required no more than 5 mm expansion in the intermolar region. INTERVENTION RME was done using a Hyrax expander with daily activation of one-quarter turn per day for a period of 15-20 days (0.25 mm per day). MAIN OUTCOME MEASURE Audiometry and tympanometry readings at the baseline as compared to the post expansion and at the end of 6 months retention period. RESULTS There were no significant changes in the hearing levels on the audiometry test after RME on the cleft side (p-value -0.51) and the noncleft side ear (p-value -0.26). No significant changes were observed in the middle ear volume on the tympanometry test after RME on the cleft side (p-value -0.09) and the noncleft side ear (p-value -0.28). CONCLUSION There was no improvement or deterioration in the hearing levels after RME and at the end of 6 months retention period in UCLP patients as evaluated using pure tone audiometry and tympanometry test. Hence RME may be undertaken in UCLP patients safely in terms of hearing is concerned.
Collapse
Affiliation(s)
- Kaleem Fatima
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Kumar Chaudhari
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Duggal
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Om P Kharbanda
- Dr CG Pandit National Chair of ICMR, Department of Plastic Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
2
|
MacKeith S, Mulvaney CA, Galbraith K, Webster KE, Paing A, Connolly R, Marom T, Daniel M, Venekamp RP, Schilder AG. Adenoidectomy for otitis media with effusion (OME) in children. Cochrane Database Syst Rev 2023; 10:CD015252. [PMID: 37870083 PMCID: PMC10591285 DOI: 10.1002/14651858.cd015252.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Otitis media with effusion (OME) is an accumulation of fluid in the middle ear cavity, common amongst young children. The fluid may cause hearing loss. When persistent, it may lead to developmental delay, social difficulty and poor quality of life. Management of OME includes watchful waiting, autoinflation, medical and surgical treatment. Adenoidectomy has often been used as a potential treatment for this condition. OBJECTIVES To assess the benefits and harms of adenoidectomy, either alone or in combination with ventilation tubes (grommets), for OME in children. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 20 January 2023. SELECTION CRITERIA Randomised controlled trials and quasi-randomised trials in children aged 6 months to 12 years with unilateral or bilateral OME. We included studies that compared adenoidectomy (alone, or in combination with ventilation tubes) with either no treatment or non-surgical treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Primary outcomes (determined following a multi-stakeholder prioritisation exercise): 1) hearing, 2) otitis media-specific quality of life, 3) haemorrhage. SECONDARY OUTCOMES 1) persistence of OME, 2) adverse effects, 3) receptive language skills, 4) speech development, 5) cognitive development, 6) psychosocial skills, 7) listening skills, 8) generic health-related quality of life, 9) parental stress, 10) vestibular function, 11) episodes of acute otitis media. We used GRADE to assess the certainty of evidence for each outcome. Although we included all measures of hearing assessment, the proportion of children who returned to normal hearing was our preferred method to assess hearing, due to challenges in interpreting the results of mean hearing thresholds. MAIN RESULTS We included 10 studies (1785 children). Many of the studies used concomitant interventions for all participants, including insertion of ventilation tubes or myringotomy. All included studies had at least some concerns regarding the risk of bias. We report results for our main outcome measures at the longest available follow-up. We did not identify any data on disease-specific quality of life for any of the comparisons. Further details of additional outcomes and time points are reported in the review. 1) Adenoidectomy (with or without myringotomy) versus no treatment/watchful waiting (three studies) After 12 months there was little difference in the proportion of children whose hearing had returned to normal, but the evidence was very uncertain (adenoidectomy 68%, no treatment 70%; risk ratio (RR) 0.97, 95% confidence interval (CI) 0.65 to 1.46; number needed to treat to benefit (NNTB) 50; 1 study, 42 participants). There is a risk of haemorrhage from adenoidectomy, but the absolute risk appears small (1/251 receiving adenoidectomy compared to 0/229, Peto odds ratio (OR) 6.77, 95% CI 0.13 to 342.54; 1 study, 480 participants; moderate certainty evidence). The risk of persistent OME may be slightly lower after two years in those receiving adenoidectomy (65% versus 73%), but again the difference was small (RR 0.90, 95% CI 0.81 to 1.00; NNTB 13; 3 studies, 354 participants; very low-certainty evidence). 2) Adenoidectomy (with or without myringotomy) versus non-surgical treatment No studies were identified for this comparison. 3) Adenoidectomy and bilateral ventilation tubes versus bilateral ventilation tubes (four studies) There was a slight increase in the proportion of ears with a return to normal hearing after six to nine months (57% adenoidectomy versus 42% without, RR 1.36, 95% CI 0.98 to 1.89; NNTB 7; 1 study, 127 participants (213 ears); very low-certainty evidence). Adenoidectomy may give an increased risk of haemorrhage, but the absolute risk appears small, and the evidence was uncertain (2/416 with adenoidectomy compared to 0/375 in the control group, Peto OR 6.68, 95% CI 0.42 to 107.18; 2 studies, 791 participants). The risk of persistent OME was similar for both groups (82% adenoidectomy and ventilation tubes compared to 85% ventilation tubes alone, RR 0.96, 95% CI 0.86 to 1.07; very low-certainty evidence). 4) Adenoidectomy and unilateral ventilation tube versus unilateral ventilation tube (two studies) Slightly more children returned to normal hearing after adenoidectomy, but the confidence intervals were wide (57% versus 46%, RR 1.24, 95% CI 0.79 to 1.96; NNTB 9; 1 study, 72 participants; very low-certainty evidence). Fewer children may have persistent OME after 12 months, but again the confidence intervals were wide (27.2% compared to 40.5%, RR 0.67, 95% CI 0.35 to 1.29; NNTB 8; 1 study, 74 participants). We did not identify any data on haemorrhage. 5) Adenoidectomy and ventilation tubes versus no treatment/watchful waiting (two studies) We did not identify data on the proportion of children who returned to normal hearing. However, after two years, the mean difference in hearing threshold for those allocated to adenoidectomy was -3.40 dB (95% CI -5.54 to -1.26; 1 study, 211 participants; very low-certainty evidence). There may be a small reduction in the proportion of children with persistent OME after two years, but the evidence was very uncertain (82% compared to 90%, RR 0.91, 95% CI 0.82 to 1.01; NNTB 13; 1 study, 232 participants). We noted that many children in the watchful waiting group had also received surgery by this time point. 6) Adenoidectomy and ventilation tubes versus non-surgical treatment No studies were identified for this comparison. AUTHORS' CONCLUSIONS When assessed with the GRADE approach, the evidence for adenoidectomy in children with OME is very uncertain. Adenoidectomy may reduce the persistence of OME, although evidence about the effect of this on hearing is unclear. For patients and carers, a return to normal hearing is likely to be important, but few studies measured this outcome. We did not identify any evidence on disease-specific quality of life. There were few data on adverse effects, in particular postoperative bleeding. The risk of haemorrhage appears to be small, but should be considered when choosing a treatment strategy for children with OME. Future studies should aim to determine which children are most likely to benefit from treatment, rather than offering interventions to all children.
Collapse
Affiliation(s)
- Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Caroline A Mulvaney
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Kevin Galbraith
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Aye Paing
- Guideline Development Team A, NICE, London, UK
| | | | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - Mat Daniel
- Nottingham Children's Hospital, Nottingham, UK
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne Gm Schilder
- evidENT, Ear Institute, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, University College London, London, UK
| |
Collapse
|
3
|
Wafae MM, Abdelkadr HM, Alazeem BEA. Conservative management versus ventilation tube insertion in children with otitis media with effusion accompanying cleft palate. AL-AZHAR ASSIUT MEDICAL JOURNAL 2023; 21:1-8. [DOI: 10.4103/azmj.azmj_116_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
|
4
|
Funamura JL, Lee JW, McKinney S, Bayoumi AG, Senders CW, Tollefson TT. Children with Cleft Palate: Predictors of Otologic Issues in the First 10 Years. Otolaryngol Head Neck Surg 2019; 160:902-910. [DOI: 10.1177/0194599818825461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To evaluate the characteristics of children with cleft palate associated with persistent otologic issues in the first 10 years of life. Study Design Case series with chart review. Setting Single academic center. Subjects and Methods Children born with cleft palate from 2003 to 2007 and treated by the UC Davis Cleft and Craniofacial Team between January 2003 and December 2017 were included in the study. Data from 143 patients were analyzed via Wilcoxon rank sum and Fisher exact tests for univariate analysis and logistic regression to determine adjusted odds ratios. Results The median length of follow-up was 9.9 years, and the age at last ear examination was 10.7 years. At the last evaluation, unresolved otologic issues were common, with at least 1 ear having a tympanic membrane (TM) perforation (16.1%), a tympanostomy tube (36.2%), or conductive hearing loss (23.1%). After adjusting for demographic and clinical characteristics, history of palate revision or speech surgery was associated with having a TM perforation ( P = .02). The only clinical variables associated with conductive hearing loss was the presence of a TM perforation ( P < .01) or a genetic abnormality ( P = .02). Severity of palatal clefting was not associated with specific otologic or audiologic outcomes after adjusting for other characteristics. Conclusion A large proportion of children with cleft palate have persistent otologic issues at age 10 years and would benefit from continued close monitoring well after the age when most children have normalized eustachian tube function. Prolonged otologic issues were not found to be associated with cleft type.
Collapse
Affiliation(s)
- Jamie L. Funamura
- Department of Otolaryngology–Head and Neck Surgery, UC Davis Health, Sacramento, California, USA
| | - Janet W. Lee
- Department of Otolaryngology–Head and Neck Surgery, UC Davis Health, Sacramento, California, USA
| | - Samantha McKinney
- Department of Otolaryngology–Head and Neck Surgery, UC Davis Health, Sacramento, California, USA
| | - Ahmed G. Bayoumi
- Department of Otolaryngology–Head and Neck Surgery, UC Davis Health, Sacramento, California, USA
| | - Craig W. Senders
- Department of Otolaryngology–Head and Neck Surgery, UC Davis Health, Sacramento, California, USA
| | - Travis T. Tollefson
- Department of Otolaryngology–Head and Neck Surgery, UC Davis Health, Sacramento, California, USA
| |
Collapse
|
5
|
Karanth TK, Whittemore KR. Middle-ear disease in children with cleft palate. Auris Nasus Larynx 2018; 45:1143-1151. [DOI: 10.1016/j.anl.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
|
6
|
Abstract
This study presents a systematic review of randomized controlled trials (RCTs) in cleft and craniofacial surgery. All studies reporting on RCTs in cleft and craniofacial surgery were identified on PubMed using the search terms "cleft," "velopharyngeal insufficiency," "velopharyngeal dysfunction," "nasoalveolar molding," "gingivoperiosteoplasty," "Pierre Robin sequence," "craniofacial," "craniosynostosis," "craniofacial microsomia," "hemifacial microsomia," "hypertelorism," "Le Fort," "monobloc," "distraction osteogenesis," "Treacher Collins," and "Goldenhar." Studies were excluded if they were not randomized, did not focus primarily on topics related to cleft or craniofacial surgery, included repeat publications of data, or were unavailable in English. Studies were evaluated on demographic and bibliometric data, study size, specific area of focus, and findings reported. Four hundred forty-seven unique studies were identified. One hundred eighty-three papers met inclusion criteria (115 cleft lip and palate, 65 craniofacial, and 3 spanning both disciplines). Sixty-six (36%) were dedicated to topics related to surgical techniques. There were no studies comparing current cleft lip or soft palate repair techniques and no studies on cleft rhinoplasty. The most frequently reported surgical topic was cleft palate. There were several studies on orthognathic techniques which compared distraction osteogenesis to traditional advancement. Most craniofacial operations, such as cranial vault remodeling and frontofacial advancement/distraction, were not represented. Several standard operations in cleft and craniofacial surgery are not supported by Level I evidence from randomized controlled trials. Our community should consider methods by which more RCTs can be performed, or redefine the acceptable standards of evidence to guide our clinical decisions.
Collapse
|
7
|
D'Andréa G, Maschi C, Savoldelli C, Caci H, Bailleux S. Otologic Outcomes With Two Different Surgical Protocols in Patients With a Cleft Palate: A Retrospective Study. Cleft Palate Craniofac J 2018; 55:1289-1295. [PMID: 29489418 DOI: 10.1177/1055665618758686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare otologic outcomes in patients with cleft palate who underwent 2 different surgical protocols. DESIGN Monocentric retrospective analysis of medical reports. PATIENTS, PARTICIPANTS All consecutively treated patients affected by a cleft palate, born between January 1998 and December 2002 (group 1) and between January 2007 and December 2010 (group 2). INTERVENTIONS Patients in group 1 underwent Veau-Wardill-Kilner palatoplasty at 10 months and had ventilation tubes inserted in case of otitis media with effusion (OME) during surgery. Patients in group 2 underwent Sommerlad intravelar veloplasty at 5 months. Ventilation tubes were inserted only in case of persistent OME. MAIN OUTCOME MEASURE(S) The need for a second set of ventilation tubes to be inserted in case of persistent OME, the presence of OME at the age of 2 years, and tympanic abnormalities at the age of 5 years were analyzed. RESULTS There was no statistically significant difference either for the presence of OME at the age of 2 years (27 [45%] vs 32 [57.14%], respectively, in groups 1 and 2; P = .191) or for tympanic abnormalities at the age of 5 years (20 [33.33%] vs 15 [26.79%]; P = .433). Statistically significant difference was found for the need to insert a second set of ventilation tubes in case of persistent OME (29 [48.33%] vs 12 [21.42%], respectively; P = .02). CONCLUSION Early Sommerlad intravelar veloplasty may reduce persistent OME and consequently the need for ventilation tubes insertion, compared to later Veau-Wardill-Kilner palatoplasty.
Collapse
Affiliation(s)
- Grégoire D'Andréa
- 1 Hôpitaux Pédiatriques de Nice CHU Lenval, Nice, France.,2 Institut Universitaire de la Face et du Cou, CHU Nice, Nice, France
| | - Claude Maschi
- 1 Hôpitaux Pédiatriques de Nice CHU Lenval, Nice, France
| | - Charles Savoldelli
- 1 Hôpitaux Pédiatriques de Nice CHU Lenval, Nice, France.,2 Institut Universitaire de la Face et du Cou, CHU Nice, Nice, France
| | - Hervé Caci
- 1 Hôpitaux Pédiatriques de Nice CHU Lenval, Nice, France
| | | |
Collapse
|
8
|
Shaffer AD, Ford MD, Choi SS, Jabbour N. Should Children With Cleft Palate Receive Early Long-Term Tympanostomy Tubes. Cleft Palate Craniofac J 2017; 55:389-395. [DOI: 10.1177/1055665617736775] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To determine whether children with cleft palate might benefit from early long-term tympanostomy tubes with the hypothesis that receiving multiple tubes is associated with shorter duration of first tubes. Design: Retrospective cohort study. Setting: Tertiary care children’s hospital. Participants: Records from 401 consecutive children with cleft palate ± cleft lip, born April 2005 to April 2010, were reviewed. After exclusion of children with cleft repair at an outside hospital, no follow-up after 5 years of age, intact secondary palate, no tubes, or tube replacement at palatoplasty, 105 children remained. Main Outcome Measure: Number of tubes. Results: Armstrong grommet tubes were placed at a median age of 6.7 months (range 2.3-19.6 months). Tubes were replaced in 55.3% of patients, with 34.0% receiving ≥3 sets. Duration of first tubes was significantly longer for children with 1 set of tubes compared with those with multiple sets (median 26 vs 19 months, P = .004). Otorrhea, but not perforation, was associated with longer duration of first tubes (median 27 vs 20.5 months, P = .028). Cleft type did not impact the proportion of patients with multiple tubes. Median age at last tube placement for children with multiple tubes was 5.0 years (range 1.9-8.7 years). Conclusion: Short duration of first tubes is associated with receiving multiple tubes. Because most patients require repeat tubes and many require tubes until school age, there is a significant need for controlled, prospective trials of early long-term tube placement in this population.
Collapse
Affiliation(s)
- Amber D. Shaffer
- Department of Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Matthew D. Ford
- Cleft-Craniofacial Center, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Sukgi S. Choi
- Department of Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Noel Jabbour
- Department of Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| |
Collapse
|
9
|
Hamed MA, Nakata S, Sayed RH, Ueda H, Badawy BS, Nishimura Y, Kojima T, Iwata N, Ahmed AR, Dahy K, Kondo N, Suzuki K. Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives. Clin Exp Otorhinolaryngol 2016; 9:298-308. [PMID: 27440129 PMCID: PMC5115149 DOI: 10.21053/ceo.2015.01662] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 11/22/2022] Open
Abstract
Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords 'aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.' In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.
Collapse
Affiliation(s)
- Mahmood A Hamed
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Seiichi Nakata
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Ramadan H Sayed
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hiromi Ueda
- Department of Otolaryngology, Aichi Medical University, Nagakute, Japan
| | - Badawy S Badawy
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Yoichi Nishimura
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Takuro Kojima
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Noboru Iwata
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Ahmed R Ahmed
- Department of Pathology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Khalid Dahy
- Department of Otolaryngology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Naoki Kondo
- Department of Pathology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kenji Suzuki
- Department of Otolaryngology, Second Hospital, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Otolaryngology, Yonaha General Hospital, Kuwana, Japan
| |
Collapse
|
10
|
Bruce I, Harman N, Williamson P, Tierney S, Callery P, Mohiuddin S, Payne K, Fenwick E, Kirkham J, O'Brien K. The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation. Health Technol Assess 2016; 19:1-374. [PMID: 26321161 DOI: 10.3310/hta19680] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate. OBJECTIVES To identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies. DESIGN The management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP. SETTING The survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients' homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting. PARTICIPANTS Clinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association. RESULTS The clinician survey revealed that care was predominantly delivered via a 'hub-and-spoke' model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research. CONCLUSIONS There exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered. FUNDING The National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
Collapse
Affiliation(s)
- Iain Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children's Hospital, Manchester, UK
| | - Nicola Harman
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
| | - Paula Williamson
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK.,Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephanie Tierney
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Jamie Kirkham
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
| |
Collapse
|
11
|
Harman NL, Bruce IA, Kirkham JJ, Tierney S, Callery P, O'Brien K, Bennett AMD, Chorbachi R, Hall PN, Harding-Bell A, Parfect VH, Rumsey N, Sell D, Sharma R, Williamson PR. The Importance of Integration of Stakeholder Views in Core Outcome Set Development: Otitis Media with Effusion in Children with Cleft Palate. PLoS One 2015; 10:e0129514. [PMID: 26115172 PMCID: PMC4483230 DOI: 10.1371/journal.pone.0129514] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022] Open
Abstract
Background Approximately 75% of children with cleft palate (CP) have Otitis Media with Effusion (OME) histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS). Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited. Methods and Findings A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT) surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of “consensus in” to form the recommended COS: hearing; chronic otitis media (COM); OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM); cholesteatoma; side effects of treatment; listening skills; otalgia. Conclusions We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals, parents and children.
Collapse
Affiliation(s)
- Nicola L. Harman
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Iain A. Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Jamie J. Kirkham
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Stephanie Tierney
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Manchester, United Kingdom
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, United Kingdom
| | | | - Raouf Chorbachi
- North Thames Cleft Service and the Department of Audiological Medicine/ Audiology/Cochlear implants. Great Ormond Street Hospital for Children, London, United Kingdom
| | - Per N. Hall
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Anne Harding-Bell
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Victoria H. Parfect
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, Department of Health & Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Debbie Sell
- North Thames Cleft Service, Speech and Language Therapy, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ravi Sharma
- North West, Isle of Man and North Wales Cleft Lip and Palate Network, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
12
|
Jackler RK, Santa Maria PL, Varsak YK, Nguyen A, Blevins NH. A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction. Laryngoscope 2015; 125 Suppl 4:S1-S14. [PMID: 26013635 DOI: 10.1002/lary.25261] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/20/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVES/HYPOTHESIS Although the migration of its squamous outer surface of the tympanic membrane has been well characterized, there is a paucity of data available concerning the migratory behavior of its medial mucosal surface. Existing theories of primary acquired cholesteatoma pathogenesis do not adequately explain the observed characteristics of the disease. We propose a new hypothesis, based upon a conjecture that mucosal membrane interactions are the driving force in cholesteatoma. STUDY DESIGN A retrospective chart review and a prospective observational cohort study in rats. METHODS After developing the new theory, it was tested through both clinical and experimental observations. To evaluate whether impairment of middle ear mucociliary migration would influence cholesteatoma formation, a retrospective chart review evaluating cholesteatoma occurrence in a sizable population of patients with either primary ciliary dyskinesia (PCD) or cystic fibrosis (CF) was performed. To study mucosal migration on the medial aspect of the tympanic membrane, ink tattoos were monitored over time in a rat model. RESULTS No cholesteatomas were identified in either PCD patients (470) or in CF patients (1,910). In the rat model, mucosa of the posterior pars tensa migrated toward the posterior superior quadrant, whereas the mucosa of the anterior pars tensa migrated radially toward the annulus. CONCLUSION Mucosal coupling with traction generated by interaction of migrating opposing surfaces provides the first comprehensive theory that explains the observed characteristics of primary acquired cholesteatoma. The somewhat counterintuitive hypothesis that cholesteatoma is fundamentally a mucosal disease has numerous therapeutic implications.
Collapse
Affiliation(s)
- Robert K Jackler
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Peter L Santa Maria
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Yasin K Varsak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Anh Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| |
Collapse
|
13
|
Updates and knowledge gaps in cholesteatoma research. BIOMED RESEARCH INTERNATIONAL 2015; 2015:854024. [PMID: 25866816 PMCID: PMC4381684 DOI: 10.1155/2015/854024] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
The existence of acquired cholesteatoma has been recognized for more than three centuries; however, the nature of the disorder has yet to be determined. Without timely detection and intervention, cholesteatomas can become dangerously large and invade intratemporal structures, resulting in numerous intra- and extracranial complications. Due to its aggressive growth, invasive nature, and the potentially fatal consequences of intracranial complications, acquired cholesteatoma remains a cause of morbidity and death for those who lack access to advanced medical care. Currently, no viable nonsurgical therapies are available. Developing an effective management strategy for this disorder will require a comprehensive understanding of past progress and recent advances. This paper presents a brief review of background issues related to acquired middle ear cholesteatoma and deals with practical considerations regarding the history and etymology of the disorder. We also consider issues related to the classification, epidemiology, histopathology, clinical presentation, and complications of acquired cholesteatoma and examine current diagnosis and management strategies in detail.
Collapse
|
14
|
Skuladottir H, Sivertsen A, Assmus J, Remme AR, Dahlen M, Vindenes H. Hearing outcomes in patients with cleft lip/palate. Cleft Palate Craniofac J 2014; 52:e23-31. [PMID: 24805872 DOI: 10.1597/13-009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective : Children with cleft lip and palate or cleft palate only have a high incidence of conductive hearing loss from otitis media with effusion. Studies demonstrating longitudinal results are lacking. This study was undertaken to investigate long-term longitudinal hearing outcomes of children with cleft lip and/or cleft palate and cleft palate only. Design : Retrospective chart review. Setting : Clinical charts of patients born with cleft lip and palate or cleft palate only in 1985 to 1994 who were referred to the cleft team in Bergen, Norway. Study findings include 15 years of follow-up. Participants : The study population consisted of 317 children of whom 159 had nonsyndromic cleft lip and palate and 158 had nonsyndromic cleft palate. Main Outcome Measures : Pure tone average calculated from pure tone audiometry at ages 4, 6, and 15 years. Results : The median pure tone average significantly improved with increasing age. For the cleft lip and palate group, the median pure tone average at ages 4, 6, and 15 years was 16 dB hearing level (HL), 13 dB HL, and 9 dB HL, respectively (P ≤ .001). In the cleft palate group the median pure tone average at ages 4, 6, and 15 years was 15 dB HL, 12 dB HL, and 9 dB HL, respectively (P ≤ .001). There was no significant difference in the hearing levels between the two groups. Patients who had surgical closure of the palate at age 18 months had a significantly better pure tone average outcome at age 15 compared with patients who had surgery at 12 months. Conclusions : Hearing improves significantly from childhood to adolescence in patients with cleft lip and palate and cleft palate only.
Collapse
|
15
|
Impact of cleft palate type on the incidence of acquired cholesteatoma. Int J Pediatr Otorhinolaryngol 2013; 77:695-8. [PMID: 23402698 DOI: 10.1016/j.ijporl.2013.01.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/16/2013] [Accepted: 01/18/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objectives of this study were to determine the incidence of acquired cholesteatoma in children with congenital cleft palate, and to determine the impact of various cleft palate types (cleft lip and palate, cleft palate alone, submucous cleft palate) on the development of acquired cholesteatoma. MATERIALS AND METHODS This is a retrospective cohort study spanning a 25-year period from 1981 to 2005. The Cleft Palate Registry at the Hospital for Sick Children in Toronto, Canada was cross-referenced with the hospital's surgical pathology database to identify all children with cleft palate and acquired cholesteatoma. Accuracy and completeness of the datasets were confirmed by comparison with hospital records and other databases. RESULTS There were 2737 children who underwent palatoplasty over the study period, and 44 of these children developed an acquired cholesteatoma. Adjusting for censored data by Kaplan Meier analysis, the incidence of cholesteatoma was 2.2% between the ages 5 and 18 years, or 0.2% per year. Acquired cholesteatoma was 3 times more common in cleft lip and palate than cleft palate alone (p=0.002, Kaplan Meier Log-rank survival analysis). CONCLUSIONS The rate of acquired cholesteatoma in children with cleft palate is approximately 200 times the baseline rate. Children, especially teenagers, with cleft lip and palate appear to be at significantly higher risk for acquired cholesteatoma than children with cleft palate alone.
Collapse
|
16
|
Kobayashi H, Sakuma T, Yamada N, Suzaki H. Clinical outcomes of ventilation tube placement in children with cleft palate. Int J Pediatr Otorhinolaryngol 2012; 76:718-21. [PMID: 22386274 DOI: 10.1016/j.ijporl.2012.02.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 02/01/2012] [Accepted: 02/03/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the long-term clinical outcomes in children with cleft palate. METHODS One hundred eight patients with cleft palate (CP) were investigated. Microscopic observation of the middle ears was performed periodically. If chronic otitis media with effusion (OME) was diagnosed at 1 year of age or later, ventilation tube (VT) placement was performed. The air-filled area of the mastoid air cells was checked on X-rays obtained at 1 and 5 years. The data from each measurement were tested statistically by the bootstrap method and Wilcoxon's rank-sum test. The clinical course from age 6 to the final examination (average 9.42 years) and the language development at 5 years were analyzed using data from the medical records of individual patients. RESULTS VT placements were performed at 5 years of age or younger in 41 CP patients (82 ears, 38%). About 30% of patients treated by VT placement at 5 years of age or younger required myringotomy and/or VT re-placement at 6 years of age or over. Ninety-five percent of patients who had not been treated by VT insertion at 5 years of age or younger showed a favorable subsequent clinical course. Patients treated by VT insertion at 5 years of age or younger had significantly smaller mastoid air cell areas as measured at 5 years of age and also at 1 year of age. No significant difference in language development was observed between the CP patients that underwent /did not undergo VT placement. CONCLUSIONS VT placement should be positively undertaken in CP children who have small mastoid air cell areas as measured at 1 year of age, because an unfavorable prognosis of OME is expected in such patients. It is considered that patients treated by VT placement at 5 years of age or younger should be carefully followed up for the development of OME even after 6 years of age. Thus, measurement of the mastoid air cell area at the age of 1 year is useful for determining the therapeutic program.
Collapse
Affiliation(s)
- Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
| | | | | | | |
Collapse
|
17
|
Mozet C, Prettin C, Dietze M, Fickweiler U, Dietz A. Use of Floseal and effects on wound healing and pain in adults undergoing tonsillectomy: randomised comparison versus electrocautery. Eur Arch Otorhinolaryngol 2011; 269:2247-54. [DOI: 10.1007/s00405-011-1904-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 12/20/2011] [Indexed: 02/06/2023]
|