Did we get lost in the Seventies? Adenoidectomy for middle ear disease
in cleft palate children: a systematic review.
OBJECTIVES: Cleft palate children have a higher incidence of otitis
media with effusion, more frequent recurrent acute otitis media
episodes, and worse conductive hearing losses than non-cleft children.
Nevertheless, data on adenoidectomy for middle ear disease in this
patient group is scarce, since many feared worsening of velopharyngeal
insufficiency after the procedure. This review aims at filling this
knowledge gap by collecting the available evidence on this subject, to
frame possible further areas of research and interventions. DESIGN: A
PRISMA-compliant systematic review was performed. Multiple databases
were searched with criteria designed to include all studies focusing on
the role of adenoidectomy in treating middle ear disease in cleft palate
children. After duplicate removal, abstract and full-text selection, and
quality assessment, we reviewed eligible articles for clinical
indications and outcomes. RESULTS: Among 321 unique citations, 3 studies
were deemed eligible (2 case series and a retrospective cohort study).
The outcomes were positive in all three articles in terms of conductive
hearing loss improvement, recurrent otitis media episodes reduction, and
effusive otitis media resolution (this last result being not
statistically significant). CONCLUSION: Despite promising results,
research on adenoidectomy in treating middle ear disease in the cleft
population has stopped in the mid-Seventies. No data is therefore
available on the role of modern conservative adenoidectomy techniques
(endoscopic and/or partial) in this context. Prospective studies are
required to define the role of adenoidectomy in cleft children, most
interestingly in specific subgroups such as patients requiring
re-tympanostomy, given their known risk of otologic sequelae.