Optimal Timing for Auditory Brainstem Response After Tympanostomy Tube Placement in Children with Cleft Lip and Palate: A Retrospective Study.

Abstract

Objective: Children with cleft lip and/or palate (CLP) commonly present with otitis media with effusion (OME), with increased referrals for newborn hearing screening (NHS). Auditory brainstem response (ABR) testing with OME may mimic sensorineural hearing loss. This study evaluated NHS and ABR findings on and optimal timing for ABR reassessment after tympanostomy in patients with CLP. Methods: We conducted a retrospective study reviewing 271 CLP cases at our institution. The data included the cleft type, NHS results, ABR findings, OME incidence, and tympanostomy rate. Subgroup analyses compared ABR results before and after tympanostomy and via postoperative timing. Statistical comparisons were performed using the Mann-Whitney U test and Fisher's exact test. Results: The NHS referral rate was 14.0%, and the OME incidence was 48.7%. These cases occurred in patients with cleft palate involvement, with an OME prevalence of 73.4%. Tympanostomy was performed in 72.6% of cases. Among 36 ears tested pre- and post-tympanostomy, wave V thresholds improved from 61.67 ± 16.08 to 34.72 ± 6.54 dBnHL (p < 0.0001), and wave I latency decreased from 2.27 ± 0.36 to 1.76 ± 0.12 ms (p < 0.0001). Postoperative wave V thresholds were significantly better in the ≥15-day group (p = 0.037), with 65% (17/26) of ears showing thresholds <40 dBnHL compared to 25% (3/12) in the <15-day group (p = 0.035). No timing-related differences were found regarding wave I latency. Conclusions: Tympanostomy significantly improved the ABR results in children with CLP and OME. Reassessment on or after postoperative day 15 may yield more accurate results and may help to reduce parental anxiety.