Ear Problems

Ear Problems

Children afflicted with a cleft of the soft palate are predisposed to middle ear infections. The reason for this becomes clear on review of the anatomy of the soft palate musculature. The elevator veli palatini and tensor veli palatini,
which are normally inserted into the same muscles on the opposite side, are left unattached when the soft palate is cleft. These muscles have their origins either directly on or near the auditory tube. These muscles allow opening of the ostium of this tube into the nasopharynx.This action is demonstrated when middle ear pressures are equalized by swallowing during changes in atmospnerte pressure, as when ascending or descending in an airplane, when this function is disrupted, them  ear is essentially a closed space, without a drainage mechanism. Serous fluid may then  ccumulate and result in serous. otitis media. Should bacteria find their way from the  nasopharynx into the middle ear, an infection can develop (i.e., suppurative otitis media). To make matters worse the auditory tube in infants is at an angle that does not promote dependent· drainage. With age this angulation changes and allows more dependent drainage of (he middle
ear.  Children afflicted ~ith cleft palate will frequently needto have their middle ear “vented.” The otorhinolaryngologist, who creates a hole through the inferior aspect of the tympanic membrane and inserts a small plastic tube, performs  this procedure, which drains the ear to the outsideInstead of the nasopharynx (myringotomy). Chronic serous otitis media is common among children with cleft palate, and multiple myringotomies are
frequently nece ssary. Chronic serous otitis media presentsa serious threat to hearing. Because of the chronic inflammation in the iniddle ear, hearing impalements are common in patients with cleft palate. The type of hearing loss experienced by the patient with cleft palateis conductive, meaning that theneural pathway to the brain continues •to function normally. The defect in these instances is simply that sound cannot reach the· auditory sensory organ as efficierrtly as it should because of the chronic inflammatory
changes  in the middle ear. However, if the problem isnot corrected, permanent damage to the auditory sensory nerves (i.e., sensory neural loss) can also result. This type of damage is irreparable. The range of hearing impairment found in individuals with cleft palates is vast. The loss can be great enough so that normal-sounding speech is heard at less than one half of expected volume. In addition, certain sounds of speech (called phonemes), such as the 5, sh, and t sounds, may be heard poorly. Audio grams are useful tools and are performed repeatedly on patients with palates, to monttorhearlng ability and performance

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