Assessment of Affected Middle and Inner Ear of Children with Cleft Lips/Palates with Wide Band Tympanometry and Brainstem Auditory Response Measurements.

Öz

In this study, we aimed to evaluate the middle and inner ear function of children operated for diagnosis of cleft palate with or without cleft lip using objective test methods and to compare them with healthy individuals group. In addition, it was also aimed to determine the middle ear parameters of the Wide Band Tympanometer test, which is a new test method. For this purpose, 23 patients (46 ears) between 1 and 5 years of age, who had been previously treated with a cleft palate and successfully repaired, were included in the patient group. Twenty-three cases (46 ears) with no known health problems and ages between 1 and 5 years constituted the control group. Both groups were applied diagnostic air and bone conducted brainstem auditory evoked potentials test and Wide Band Tympanometer test. In the patient group, in the air conducted brainstem auditory evoked potentials test, the threshold of wave V was significantly higher than the control group, and there was no significant difference between two groups in the bone conducted brainstem auditory evoked potentials test. In the Wide Band Tympanometer test in the patient group, there was a significant difference in pressure absorbance values and tympanogram peak pressures compared to the control group, but no significant difference was found between two groups in the ear canal volume and resonance frequency values. As a result of the tests conducted in the patient group, a total of 19 (41.3%) ears was found with otitis media with effusion and 2 (4.3%) ears had profound sensorineural hearing loss. Twenty-five (54.4%) ears were found to be healthy. The fact that the otitis media with effusion frequency is as high as 41% even after repairmen of cleft palate, reveals the necessity of long-term follow-up at regular intervals by using audiological tests and physical examination.

Anahtar Kelimeler

• brainstem auditory evoked potentials
• cleft palate
• hearing loss
• otitis media with effusion
• wideband tympanometry

Yarık Damak-Yarık Dudaklı Çocuk Hastalarda Orta ve İç Kulak Etkilenmesinin Geniş Band Timpanometri, Hava ve Kemik Yolu İşitsel Beyin Sapı Potansiyel Ölçümleri ile Değerlendirilmesi

Öz

Bu çalışmada, yarık dudak patolojisinin eşlik ettiği veya etmediği yarık damak tanısı ile opere edilmiş çocuk olgularda; objektif test yöntemleri ile orta ve iç kulak fonksiyonlarını değerlendirmeyi ve kontrol grubundaki sağlıklı bireylerle karşılaştırmayı amaçladık. Ek olarak, opere edilmiş yarık damak ± yarık dudaklı hasta grubunun orta kulak parametrelerinin yeni bir test yöntemi olan Geniş Bant Timpanometre testi ile belirlenmesi amaçlanmıştır. Bu amaç doğrultusunda, daha önce yarık damak tanısı ile opere edilen ve başarılı damak onarımı yapılmış, yaşları 1-5 yıl arasında olan 23 olgu (46 kulak) hasta grubuna dahil edildi. Bilinen sağlık problemi olmayan, yaşları 1-5 yıl arasında olan 23 olgu (46 kulak) ise kontrol grubunu oluşturdu. Her iki gruba da tanısal hava ve kemik yolu İşitsel Beyinsapı Uyarılmış Potansiyelleri testi ve Geniş Bant Timpanometre testi yapıldı. Hasta grubunda hava yolu İşitsel Beyinsapı Uyarılmış Potansiyelleri testinde V. dalganın gözlendiği eşik uyaran şiddeti kontrol grubuna göre anlamlı olarak yüksek bulunurken, kemik yolu İşitsel Beyinsapı Uyarılmış Potansiyelleri testinde her iki grup arasında anlamlı farklılık saptanmadı. Geniş Bant Timpanometre testinde hasta grubunda kontrol grubuna göre; basınçlı absorbans değerleri ve timpanogram tepe basınçlarında anlamlı farklılık gözlenirken, kulak kanalı hacmi ve rezonans frekans değerlerinde her iki grup arasında anlamlı farklılık saptanmadı. Yapılan testler sonucunda hasta grubunda toplam 19 (%41.3) kulakta efüzyonlu otitis media, 2 (%4.3) kulakta da çok ileri derecede sensörinöral tip işitme kaybı gözlenmiştir. Yirmi beş (%54.4) kulak ise sağlıklı olarak saptanmıştır. Yarık damak onarım operasyonu sonrasında bile %41 gibi yüksek oranlarda efüzyonlu otitis media sıklığı olması, bu olguların odyolojik testler ve fizik muayene eşliğinde düzenli aralıklarla uzun dönem takibinin gerekliliğini ortaya koymaktadır.

Anahtar Kelimeler

• efüzyonlu otitis media
• geniş bant timpanometri
• işitme kaybı
• işitsel beyinsapı uyarılmış potansiyelleri
• yarık damak

Kaynakça

1. Referans1. Goudy S, Lott D, Canady J, Smith RJ. Conductive hearing loss and otopathology in cleft palate patients. Otolaryngology Head Neck Surg. 2006; 134(6): 946-8.
2. Referans2. Flynn T, Möller C, Jönsson R, Lohmander A. The high prevalence of otitis media with effusion in children with cleft lip and palate as compared to children without clefts. Int J Pediatr Otorhinolaryngol. 2009; 73(10): 1441-6.
3. Referans3. Sheahan P, Miller I, Sheahan JN, Earley MJ, Blayney AW. Incidence and outcome of middle ear disease in cleft lip and/or cleft palate. Int J Pediatr Otorhinolaryngol. 2003; 67(7): 785-93.
4. Referans4. Szabo C, Langevin K, Schoem S, Mabry K. Treatment of persistent middle ear effusion in cleft palate patients. Int J Pediatr Otorhinolaryngol. 2010; 74(8): 874-7.
5. Referans5. Sundman H, Flynn T, Tengroth B, Lohmander A. ABR thresholds in infants born with CLP and OME and infants with OME. Int J Pediatr Otorhinolaryngol. 2016; 81: 21-5.
6. Referans6. Hunter LL, Bagger-Sjöbäck D, Lundberg M. Wideband reflectance associated with otitis media in infants and children with cleft palate. Int J Audiology. 2008; 47(sup1): 57-61.
7. Referans7. Chen JL, Messner AH, Curtin G. Newborn hearing screening in infants with cleft palates. Otology & Neurotology. 2008; 29(6): 812-5.
8. Referans8. Viswanathan N, Vidler M, Richard B. Hearing thresholds in newborns with a cleft palate assessed by auditory brain stem response. Cleft Palate Craniofac J. 2008; 45(2): 187-92.

9. Referans9. Gümüş B, Topçu MT. Wide band acoustic immitancemetry. Med Med J. 2018; 33(2):126-31.
10. Referans10. Andrews PJ, Chorbachi R, Sirimanna T, Sommerlad B, Hartley BEJ. Evaluation of hearing thresholds in 3‐month‐old children with a cleft palate: the basis for a selective policy for ventilation tube insertion at time of palate repair. Clin Otolaryngol. 2004; 29(1): 10-7.
11. Referans11. Flynn T, Möller C, Lohmander A, Magnusson L. Hearing and otitis media with effusion in young adults with cleft lip and palate. Acta Oto-Laryngologica. 2012; 132(9): 959-66.
12. Referans12. Watson DJ, Rohrich RJ, Poole MD, Godfrey AM. The effect on the ear of late closure of the cleft hard palate. British journal of plastic surgery. 1986; 39(2): 190-2.
13. Referans13. Jordan VA, Sidman JD. Hearing outcomes in children with cleft palate and referred newborn hearing screen. The Laryngoscope. 2014; 124(9).
14. Referans14. Özgür A, Müjdeci B, Terzi S, Coşkun ZÖ, Yiğit E, Dursun E. Wideband tympanometry normative data for different age groups in Turkish population. J Int Adv Otol. 2016; 12(1).
15. Referans15. Keefe DH, Bulen JC, Arehart KH, Burns EM. Ear-canal impedance and reflection coefficient in human infants and adults. J Acoust Soc Am. 1993; 94(5): 2617-38.
16. Referans16. Kökten N, Eğilmez OK. Geniş band ve multifrekans timpanometri. Türkiye Klinikleri J ENT Special Topics. 2015; 8(2): 26-31.
17. Referans17. Moller P. Long-term otologic features of cleft palate patients. Arch Otolaryngol. 1975; 101(10): 605-7.
18. Referans18. Imbery TE, Sobin LB, Commesso E, Koester L, Tatum SA, Huang D, et al. Long-term otologic and audiometric outcomes in patients with cleft palate. Otolaryngol Head Neck Surg. 2017; 157(4): 676-82.