Does Hearing Improve Following Primary Cleft Palate Repair?

Objective: To establish the effect of cleft palate repair on hearing outcomes in children with glue ear and conductive hearing loss undergoing elective primary palatoplasty.

Methods: A retrospective chart review of all patients who underwent cleft palate repair (isolated cleft palate [CPO], unilateral cleft lip and palate [UCLP], and bilateral CLP [BCLP]) between 2020 and 2022 in a single institution. Patient demographic data and cleft type were recorded. Statistical analysis was performed on pre and postoperative audiology reports.

Results: A total of 42 children (20 males, 22 females) had cleft palate repair within the study period. The mean age at primary repair was 15.2 months (range: 8-33 months). Seven of the 42 children were syndromic and 4 had Pierre Robin sequence. Preoperatively, 36 patients (86%) were diagnosed with conductive hearing loss. A single patient had hearing aids preoperatively due to severe hearing loss. One patient had grommets inserted at the time of palatoplasty. Postoperatively, all 42 patients attended their follow-up audiology appointments (100%); 20 patients (48%) had improved hearing levels, 18 (43%) had similar hearing levels, and 4 (9%) had worse hearing levels. When stratified by cleft type (25 CPO, 9 BCLP, and 8 UCLP) no difference was noted. Four patients required hearing aids postoperatively.

Conclusions: This study confirms that primary cleft palate repair has a positive impact on audiology outcomes in patients with cleft. These findings suggest that primary cleft palate repair may improve hearing at an early stage, possibly by contributing proactively to restoring eustachian tube function and normalizing middle ear ventilation before glue ear and associated conductive hearing loss improve with patient maturity.