[Middle-ear findings in young cleft lip and palate children. Comparison of two treatment clinics].

Middle-ear findings in two groups with cleft lips and palate of the early childhood have been compared with each other. In 126 CLAP children of the Departments for Maxillofacial Surgery/ENT of the University of Hamburg tympanic cavity wash tubes (grommets) were inserted (26%) or myringotomy was done (10%) after persistence of middle ear effusions for more than 3 months. In contrast to this rather conservative approach, grommets were inserted as a primary treatment in 58 CLAP children of the Iowa Cleft Palate Center. Long-term follow-up revealed no marked middle-ear pathology in either of these groups. Repeated use of general anesthesia and the risk of othorrhoea (10-18%), however, speak against the routine practice of grommet insertion. From the otological point of view a wait-and-see strategy should be employed in the indication for grommet insertion in CLAP children after closure of the soft palate, just as it is done in the normal population (controlled intervention). Therapeutic grommet insertion performed in time will restore the normal physiology of the middle ear due to mucociliary clearance. Moreover, there is an immediate effect on the child's hearing ability thus contributing to physiological speech development. On the other hand, adequate treatment prevents defect healing sequelae such as middle-ear deafness, adhesions and cholesteatomas.