Clinical Outcomes Of Otitis Media With Effusion Following Palatoplasty And Improvement Of Sonotubometry

Objectives: To analyze the clinical outcomes of otitis media with effusion(OME)in children with incomplete cleft palate(CP)after palatoplasty prospectively.To improve the sonotubometric system and use it in the diagnosis of otitis media with effusion in children.Methods: In the first part,a total of 30 children with incomplete CP,aged between 10 months and 2 years,were enrolled in this study and received at least 6 months of follow-up evaluations after palatoplasty.All the enrolled children were evaluated by tympanometry,distortion product otoacoustic emission(DPOAE)test,auditory brainstem response(ABR),and plain CT scan of the palate on the day before surgery.Impedance audiometry and DPOAE were repeated at 1,3,6 and 12 months(if the follow-up period was one year)after surgery to assess the recovery of OME.In the second part,we investigated the physiological and acoustic characteristic parameters of the path along which the audio signals transmit from the nostril to the external auditory canal using a digital audio signal analysis.Based on our results,we proposed a more suitable test sound source signal and evaluation criteria to improve the sonotubometric system.In the third part,the improved sonotubometric system was used in children with OME and compared with otologic healthy children.Results: In the first part,the overall improvement rate of OME was as high as 26% in this group.Among the 8 children with improved OME,7(87.5%)were found to have middle ear effusion that improved within 6 months after CP repair.There was no significant difference in the improvement rate between the severe degree II group and the mild group.In the second part,we found a relatively reasonable frequency band for sonotubometry through a static experiment and a dynamic experiment with swallowing action.Specifically,the pure tone line spectrum should be approximately 3.5 kHz and in the 4.3-5.1kHz band.Moreover,this study defined the strongest moment of swallowing action and determined the changes in the sound source signal curve after the strongest moment of swallowing action.We also proposed calculating LVc>6dB as the indicator of the effective opening of the eustachian tube.In the third part,we found that the improved sonotubometric system could be applied in children older than 3.Eustachine tube opening could be detected using sonotubometry in 84.2% of children in control group and 58.3% of children in OME group.Conclusion: The incidence rate of OME is very high in children with CP.A 6-month follow-up period is recommended.The severity of incomplete CP is not fully related to the function of the eustachian tube.The pure tone line spectrum in 3.5 kHz and in the 4.3-5.1kHz band is a more reasonable test signal choice for sonotubometry.The improved sonotubometric system could be applied in children older than 3.