I. Why Are Cleft-related Ear Ailments Common?

A passageway called the Eustachian tube extends from the middle ear all the way to the oral cavity. This tube directs drainage of inner ear secretions into the throat, and can induct air into the closed inner ear cavity to maintain equilibrium of pressure on both sides of the eardrum. Collapse of the upper palate or abnormal functional disturbances of the soft palate tissue causes diminished function of the Eustachian tube. This results in failure of the Eustachian tube to drain the middle ear fluid. A build-up of fluids in the middle ear is called serous otitis media, also known as “glue ear” or more formally as “otitis media with effusion.” According to statistics, approximately 95% of all cleft palate babies of about one year old are afflicted with the common complication of otitis media.

II. How Do I Know If My Child is Affected by Middle Ear Fluid?

Signs of otitis media include diminished auditory capacity and feelings of stuffiness inside the ear. However, as most babies are unable to express these problems they go undetected by most parents. Only when fluid buildup leads to infection and chronic suppurative otitis do symptoms such as fever or outflow of ear canal secretions become apparent. In early stages of development the infant will rub or pull frequently at his ears due to discomfort, or display a slow response time to higher noise and speech volume, all of which are telltale signs of possible ear problems.

III. What Can Happen if Otitis Media Goes Untreated?

Over time, untreated otitis media leads to scarring and hardening of the eardrum membrane, the middle ear canal and fixation and scarring of the small ear bones that are important for normal hearing. Combined with suppurative otitis, damage to the eardrum membrane and middle ear canal worsens, causing permanent loss of hearing, affecting speech and language development. In addition, sufferers of chronic otitis media are very susceptible to developing cholesteatoma, which destroys the ear canal, inner ear, skull, and can even press against the brain.

IV. Diagnoses and Treatment of Otitis Media

An ear, nose and throat doctor uses an otoscope to examine whether the ear drum is normal, or conducts a hearing test to evaluate possible hearing impairment. Further, the physician may use tympanometry to detect early middle ear ailments. If there is fluid in the middle ear, the condition can be treated with appropriate drugs.If it does not improve, further treatment entails insertion of myringotomy tubes (“ear tubes”) under general anesthesia to enable the fluids to escape the middle ear cavity to improve hearing and reduce stuffiness in the ears.

Following the procedure care should be taken to keep moisture out of the ears so as to prevent suppurative otitis.

The myringotomy tubes are small plastic tubes or grommets that are inserted into a tiny incision in the eardrum. The eardrums naturally expel them within a year. Occasionally the fluid will reaccumulate, in which case additional treatment is necessary.