Unexpected Ear Disease in Infants with Cleft Palate

Abstract

The high incidence of middle ear disease in cleft palate children has been well documented; however, neither the age of onset nor the patho— genesis has been established. Accordingly, for the past two years the otolaryngology and plastic surgery services at Children's Hospital of Philadelphia have cooperated in a study which allowed systematic ex— amination of tympanic membranes and middle ears of infants prior to reconstructive surgery for cleft lip and cleft palate. Shortly after this program began, we were impressed with the high incidence of patho— logical conditions found in these infant ears. The purpose of this report is to present these unexpected findings with the hope that others will be stimulated to examine their patients in a similar manner. Method The tympanic membranes and middle ears were examined bilaterally in 25 infants ranging in age from nine days to 12 months. The entire procedure was carried out with the aid of a Zeiss binocular operating microscope at magnifications of 6X, 10x, and 16x. The usual approach to the middle ear was employed. The external ear canal was cleaned with a curette, but no attempt was made to sterilize the canal because this is time-consuming and we did not wish to add to the duration of the procedure. Cultures were not taken routinely. As shown in Figure 1, the tympanic membrane of the infant is almost horizontal and normally has a dull appearance with prominent vasculature. In contrast to the normal infant, the tympanic membrane in the cleft palate infant typically bulges slightly at its inferior portion. An incision was made through the ear drum to allow small suction tips to be introduced for aspiration of the middle ear. When technically feasible, a piece of the middle ear mucosa was removed with suction or a small cup forcep. All patients Drs. Stool and Randall are affiliated with the Children'