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Objective: To assess the otologic and audiologic status of patients with cleft lip and palate (CLP) operated in the Department of Pediatric Surgery attached to the Advanced Pediatric Centre, Post Graduate Institute of Medical Education & Research (PGIMER), India. The main idea of carrying out this study was to know the incidence of middle ear pathologies in a group where no complaints have been noticed., Setting: Research study was carried in Post Graduate Institute of Medical Education & Research (PGIMER) which is one of the tertiary care institutions in India., Participants: 55 children (Mch: 28; Fch: 27) in the age range of 4-13 years constituted the study group. These children were operated upon by the same surgeon (JKM) during the period 1996-1998 and were attending the speech clinics at PGIMER. None of these children/parents had complained of any ear problem and were taken up for the study to find out the middle ear pathology. The ontological and audiological evaluation was done for all the children., Results: 53 of 110 ears had normal hearing status. None of the ears had severe or profound hearing loss. The air conduction thresholds ranged from 20.2 to 29.63 dB across the frequencies whereas the bone conduction thresholds varied from 7.13 to 12.41 dB. Only 42% of the right (R) ears and 47% of the left (L) ears had a normal tympanic membrane., Conclusion: On the basis of this finding, investigation of the benefits of early and routine follow-up for otologic and audiologic status is warranted. Patients with cleft lip and palate should have an intense and detailed otologic and audiologic follow-up to identify any ME pathology/hearing loss so that timely intervention can be taken.

Aims: To analyse the factors affecting clinical and functional outcome of Veau-Wardill-Kilner palatoplasty in various types of cleft palate. Materials and Methods: Demographic data were retrieved from case records and a detailed speech, language and hearing and an orthodontic analysis were carried out prospectively. Results: Mean age at operation was 2.7 years; whereas mean age at the time of evaluation was 6 years. Most of the patients (43.3%, 13/30) had a bilateral cleft lip and palate. The postoperative fistula had developed in 31% (4/13) of the patients with bilateral clefts and in 17% (1/6) and 9% (1/11) of the patients with left unilateral and isolated cleft palate respectively (P<0.05). Eight per cent (2/24) of the patients operated before 2 years of age developed a fistula as compared to 66.6% (4/6) of the patients who had undergone a repair after 2 years of age (P<0.01). Severe speech abnormality was seen in 33.4% of the patients having postoperative fistula as compared to 16.6% of non-fistula patients (P<0.05). Derangement of speech was found in 66.6% of the patients who had undergone surgery after the age of 2 years as compared to the patients (13%, 3/24) undergoing correction before 2 years of age (P<0.05). Hearing loss was seen most commonly in patients with bilateral cleft palate as compared to the other varieties (P>0.05). Tympanic membrane (TM) abnormalities were also more common in bilateral cleft patients (P<0.05). Mean maxillary arch length, arch circumference and maxillary inter-canine and inter-molar width were significantly reduced as compared to the control group (P<0.001). Conclusions: Socially acceptable quality of speech can be achieved in more than 85% of the patients. The postoperative fistula is associated with poor speech; bilateral cleft and older age being the risk factors for fistula formation. Many patients require audiological surveillance even when asymptomatic. Maxillary growth is impaired in all the patients despite early surgery. [ABSTRACT FROM AUTHOR]