Factor Affecting the Receiving Repeated Ventilation Tube Insertion in Children With Cleft Palate

Abstract

Objective: To identify factors associated with repeated ventilation tube insertion (VTI) in children with cleft palate (CP) who developed otitis media with effusion (OME) before 6 years of age, and to construct a practical risk prediction scoring system. Design: Retrospective cohort study. Setting: Tertiary care academic hospital. Participants: Medical records of 127 children with CP who underwent both myringotomy with VTI and palatoplasty between 2007 and 2023 were reviewed. Patients were classified into single VTI (n = 55) and repeated VTI (n = 72) groups. Interventions: All participants received myringotomy with VTI as standard OME management. Palatoplasty techniques included intravelar veloplasty and double-opposing Z-plasty, with or without hamulus fracture. Outcome Measures: Ten potential risk factors were evaluated, including craniofacial syndromes, premyringotomy hearing level, acute otitis media history, cleft type and gap width, middle ear fluid type, tympanic membrane (TM) retraction, surgeon level, palatoplasty technique, and hamulus fracture. Logistic regression was used to develop a predictive scoring system. Results: Multivariate analysis identified thick middle ear fluid (odds ratio (OR) 3.18, P = .008), TM retraction (OR 4.06, P = .043), and premyringotomy hearing level >40 dB (OR 3.50, P = .010) as independent predictors of repeat VTI. A 0 to 4 point scoring system showed acceptable discrimination (area under the curve = 0.732). Conclusion: Children with TM retraction, thick middle ear fluid, or hearing loss >40 dB are at higher risk for repeated VTI. This scoring system supports early identification, caregiver counseling, and closer follow-up to optimize middle ear outcomes.