Does Pterygoid Hamulotomy During Palatoplasty Affect Hearing Outcomes in Nonsyndromic Cleft Palate Patients?

BACKGROUND

Cleft palate repair aims to achieve tension-free closure without compromising Eustachian tube function and hearing outcomes. The effect of pterygoid hamulotomy on postoperative hearing remains inconclusive.

PURPOSE: This study evaluated the effect of pterygoid hamulotomy during palatoplasty on hearing thresholds and middle ear status in nonsyndromic cleft palate patients.

STUDY DESIGN, SETTING, SAMPLE: This prospective double-blind study was conducted at the Department of Oral and Maxillofacial Surgery at a tertiary care hospital. Eighty nonsyndromic cleft palate patients aged 10 to 60 months were included and allocated alternately to 2 groups: Group I (palatoplasty with hamulotomy, n = 40) and Group II (palatoplasty without hamulotomy, n = 40). Those with prior palatal or ear surgery, syndromic conditions, or congenital hearing loss were excluded.

PREDICTOR VARIABLE: The predictor variable was operative technique (with or without pterygoid hamulotomy), and patients were alternately allocated to 2 groups upon enrollment.

MAIN OUTCOME VARIABLE(S): The primary outcome variable was hearing threshold measured using brainstem-evoked response audiometry preoperatively, and at 1 and 6 months postoperatively. The secondary outcome was middle ear status assessed by otoscopic examination at the same time points.

COVARIATES: Covariates included age, sex, and cleft type (complete or incomplete).

ANALYSES: Data were analyzed using a mixed-effects repeated measures analysis of variance (ANOVA) to evaluate changes in brainstem-evoked response audiometry hearing thresholds over time and between groups. χ2 tests were used for comparing categorical outcomes such as otoscopic findings. A significance level of P < .05 was considered statistically significant.

RESULTS

The final sample included 80 patients (mean age 32.7 ± 12.4 months; 53% male). At 6 months postoperatively, mean hearing thresholds improved in both groups (group I: 32.5 ± 6.4 dB to 22.8 ± 4.9 dB; group II: 33.1 ± 6.2 dB to 23.4 ± 5.1 dB), with no statistically significant difference between groups (mean difference: 0.6 dB, 95% CI: -1.3 to 2.5, P = .6). Normal middle ear status improved at 6 months in both groups (group I: 75.0%, group II: 72.5%), with no significant intergroup difference (P = .8).

CONCLUSIONS AND RELEVANCE: Hearing thresholds and middle ear status improved following palatoplasty in both groups. Pterygoid hamulotomy did not adversely affect hearing outcomes, suggesting it may be used without impacting auditory function.