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Evaluation of Otology Outcomes After Surgical Treatment of Symptomatic Pierre Robin Sequence: A Cohort Comparison Study Between Furlow Palatoplasty vs. Radical Intravelar Veloplasty
Lino F. Miele, MD, MS, Kavita Dedhia, MD, MS, David Chi, MD, Deepak Mehta, MD, Anand R. Kumar, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
Comparative outcome studies of otology outcomes (hearing loss, middle ear disease, and myringotomy rates with or without tube placement )after treatment of wide cleft palate defects seen with severe Pierre Robin Sequence (PRS) are currently limited. This study aims to compare otology outcomes in PRS patients requiring early neonatal/infant airway surgery (Tongue Lip Adhesion (TLA) vs. Mandible Distraction (DOG)) and later treated with Furlow palatoplasty (FP) or radical intravelar veloplasty (IVV).
A retrospective cohort study of symptomatic PRS patients (n=23) treated over 81 months was performed using clinical data to compare hearing loss, middle ear disease, and myringotomy rates with or without Armstrong tube placement rates between FP (Group 1) and IVV (Group 2) treatment groups. Statistical analysis between groups using a Wilcoxen signed-rank and Chi Square test was performed using SPSS 2.0.
In Group 1, the FP cohort, 10 patients were identified from September 2005- November 2009, (4 male and 6 female patients, average age at palatoplasty 1.30 years, 1 syndromic). In Group 2, the IVV cohort, 13 patients were identified from July 2007 - June 2012 (5 male and 8 female patients, average age at palatoplasty 1.57 years, 10 syndromic). The average age at oldest speech sample for FP was 3.96 years and for IVV was 2.48 (0.84 - 4.02) years (p>0.05 for all demographic variables except syndromic status p=0.003).
In Group1 (FP), n=10 (100%) vs. Group 2 (IVV), n=9 (69%) (p=0.002) were treated with tympanostomy with venting tubes at an average age of 1.03 years (0.33-1.63) vs. 1.01 years (0.45-1.44) respectively. The serous otitis, mucoid otitis, suppurative otitis media rates were 20%, 60%, and 20% in Group 1 (FP) and 11%, 78%, and 11% in Group 2 (IVV) respectively. The otorrhea rate was 30% in Group 1 and 31% in Group 2. The revision tube placement was in 20% in Group 1 and 30% in Group 2.
Average hearing test score was 19.2db in Group 1(n=8) vs. 20.75 db in Group 2 (n=8). No patients required mastoidectomy during the study period. Delayed speech acquisition, velopharyngeal incompetence, and adequate speech in group 1 was n=2 (20%), n=1 (10%), and n=5 (50%) respectively and in group 2 was n=11 (85%), n=1, (7.5%), n=1(7.5%) respectively.
Symptomatic effusions were present during the first year of life in the majority of patients with severe symptomatic Pierre Robin Sequence. Typanostomy tube placement rate was reduced in our study in patients treated with IVV when compared to Furlow palatoplasty. Hearing outcomes were similar for patients requiring typanostomy tubes in either group. Speech acquisition and subsequent speech delay was associated with syndromic status rather than type of palate repair or rate of tympanostomy tube placement.
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