ABSTRACT
To compare hearing outcomes of early versus late tympanostomy tube insertion in patients with cleft lip and palate in a resource limited setting.Retrospective cohort study.Conducted at Queen Sirikit National Institute of Child Health, a tertiary care hospital in Bangkok, Thailand.Included 76 patients under 18 with cleft anomalies undergoing tympanostomy tube insertion between January 2018 and July 2022, categorized into early (n = 11) and late (n = 65) tympanostomy groups.Early tympanostomy tube placement at ≤ 3 months old, coordinated with cleft lip repair, following failed transitory evoked otoacoustic emission (TEOAE) and Type B tympanogram. Late tympanostomy tube placement preceded by a diagnosis of middle ear effusion and typically a failed TEOAE and subsequent level of testing.Primary outcomes: normal hearing rates and age at normal hearing. Secondary outcomes: repeated tympanostomy tube placement rate, postoperative complications, and length of hospital stays.Early tympanostomy tube placement was associated with higher rates of normal hearing (100% vs. 75%. P = .103) and significantly younger age at normal hearing (11 vs. 19 months, P = .036). Time to normal hearing was shorter in the early group. Postoperative complications, including otorrhea, occurred more frequently in the early group, but differences were not significant.Early tympanostomy tube insertion improves hearing outcomes in pediatric patients with cleft lip and palate, achieving normal hearing at a significantly younger age. This approach offers a valuable alternative in resource-limited settings with constrained audiological services. Further research on long-term speech outcomes and cost-effectiveness is warranted.
ABSTRACT
Background: Outcomes of the different management in severe laryngomalacia (LM) have not been evaluated. Objective: To identify the management practices and to evaluate the outcomes in patient with severe LM. Material and Method: The medical records of LM at Queen Sirikit National Institute Child Health between January2007 and December 2012 were retrospectively reviewed. Results: Severe LM 69.8% (30/43) were found in patients diagnosed with LM. Type B (complete collapse) at 46.67% were the most common finding. Decision of management were made individually based on consideration of disease severity and comorbidity. The outcomes after management were evaluated by pre- and post-symptoms score. Post-symptoms scores were statistically significant better than pre-symptom score in all management (observation p<0.001, laser supraglottoplasty p = 0.003, and tracheotomy p = 0.001). Conclusion: Our management in severe LM include: observation, laser supraglottoplasty, and tracheostomy. The overall post-management outcome were satisfactory but the present study was limited to relatively small number of patients.
