From Volume 7, Issue 3, July 2014 | Pages 78-81
A cleft involving the palate can have a significant impact on children in relation to their hearing and airway. A normally functioning ear is important for hearing and therefore speech production. Airway difficulties in children with a cleft may be divided into neonatal, post-operative and long-term and may necessitate both acute and long-term management. As a consequence the Ear Nose and Throat specialist plays an important role within the cleft multidisciplinary team.
In relation to the Ear Nose and Throat specialist, the impact of a cleft of the palate, with or without involvement of the lip, may be divided into those issues relating to:
A normal functioning ear apparatus is essential for hearing and ultimately speech development. When a noise is created it sends a sound wave that causes vibration of the tympanic membrane. This vibration continues through the middle ear cavity via the ossicles to the cochlear. Vibration within the cochlear causes cilia to move and these movements change mechanical energy into electrical signals. These signals are transmitted to the brain through the auditory nerve (Figure 1).
Normally, the middle ear is air-filled. The eustation tubes are usually closed but are opened by the palatal musculature on swallowing, allowing air to enter; if the eustation tube is not functioning then it can become fluid-filled or the abnormal pressure can cause the tympanic membrane to retract. In cleft palate children, the abnormal development of the palatal musculature and its insertion on the eustation tube opening is thought to affect the ventilation of the middle ear. If this persists then this may cause fluid to persist, ie otitis media with effusion or ‘glue ear’. This fluid in the middle ear can attenuate sound transmission and result in a hearing loss.
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