THE MIDDLE EAR,  SECRETARY OTITIS AND VENTILATION TUBES

Children born with cleft palate are very susceptible to ear infections during the first years of their life. These infections are probably the result of abnormal development and function of the muscles of the palate. In order to understand why these infections occur, an explanation of the basics of ear anatomy is in order.
The external ear canal ends in the eardrum which separates it from the middle ear.
The middle ear is an air filled cavity which communicates with the pharynx (the back of the throat) through a small tube called the Eustachian tube. It also contains three tiny bones which transmit the sound waves from the ear drum to the inner ear and from there to the central nervous system.
When the palate muscles do not function properly, the Eustachian tube does not open to allow drainage and passage of air to the middle ear. A negative pressure forms in the middle ear as the air is absorbed, and the cavity fills with fluid. This condition is called secretary otitis media. If allowed to persist, this condition leads to hearing loss because the transmission of sound waves from the eardrum to the inner ear becomes more difficult. The fluid in the middle ear cavity may also become infected and cause a painful earache. When the fluid is not infected it does not cause any discomfort The Otolaryngologist can detect the presence of fluid in the middle ear by examining your child, and frequently by performing a very simple test at his office, called a tympanogram. If there is fluid in the middle ear, medication will be prescribed to "dry it out". If however the fluid does not clear up within a few weeks, or if the child has two or more episodes of painful earache per year, then , a minor procedure called myringotomy should be carried out, and possibly tiny ear tubes called ventilation tubes should be inserted.

 Ventilation tube

Myringotomy and ventilation tube insertion is a very simple procedure carried out on an out patient basis, sometimes in combination with another operation already scheduled for the cleft lip and palate condition. The tubes stay in place for a period of time ranging from a few weeks to several months, and then fall out on their own. If fluid accumulates again, the tubes will need to be reinserted. Complications following this procedure are minimal, and the parents should only take precautions to prevent water from entering the ear canal when tubes are in place.
Luckily, secretary otitis media tends to resolve by age four to six years, after which most children will no longer have ear problems.
Unfortunately, many physicians still believe that insertion of tubes should be avoided, and instead prescribe antibiotics. This practice, in the opinion of most cleft palate teams is wrong, for the chronic administration of antibiotics, not only does not treat the problem effectively, but may also lead to complications including making the permanent first molar teeth brittle.
To summarize: An infant born with cleft palate or cleft lip and palate should have very frequent ear examinations, the first one not later than the age of three months. If fluid is detected in the middle ear and does not clear up with medication within a few weeks, then, myringotomy and possibly ventilation tube insertion should be performed and repeated as long as fluid continues to accumulate.