The Role of Artificial Eustachian Tube in Cleft Palate Patients

Abstract

Children born with cleft palates are prone to develop middle ear prob— lems—middle ear effusions, secretory otitis media, and acute and chronic suppurative otitis media. Many investigators (1—7, 9—18) have pointed out this high incidence of middle ear pathology in cleft palate children with its concomitant conductive-type hearing loss. Tangen (18) empha— sized the frequent changes that occur in hearing and in middle ear findings on repeated examinations. Graham (2) carried this further with his longitudinal study, which showed that, at one time or another, about half of the cleft palate patients were found to have ear disease. Although the basic reason for the increased difficulty is unknown, it is presumed to be related to a poorly functioning Eustachian tube. In his classical article on the physiology of the Eustachian tube, Rich (14) demonstrated that the tensor veli palatini muscle opened the Eustachian tube as effectively when the soft palate was artificially cleft as when it was intact, because of the attachment of the muscle to the hamular proc— ess of the pterygoid. That contention has been disputed, however, par— ticularly by Holborow (5, 6'). No one has determined whether patients born with cleft palates have congenital malformation or malfunction of the tensor muscle itself, whether cleft palate surgery interferes with ten-sor function by virtue of its proximity to the hamular attachment if not by actual fracture of the hamulus, or whether change in tubal function is secondary to mucous membrane reaction around the tubal orifice from whatever cause. As a consequence of poor Eustachian tube function, the middle ear is not aerated each time the person swallows, yawns, or sneezes, as in normal function. Lacking this aeration, the oxygen in the middle ear is absorbed and a vacuum is created. One response to this vacuum is a marked retrac-tion of the tympanic membrane—~especially pars fiaccida—and subse— quently, the formation of a serous transudate which fills or partly fills the middle ear and which interferes with hearing. If the middle ear mucosa is hypertrophic, the vacuum may result in a middle ear filled with mucoid