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From
the Editor
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Editorial
Abdul Abyad (Chief Editor) |
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Original
Contributon and Clinical Investigation
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Primary
Care Physicians’ Knowledge, Attitude, and
Practice Toward Obesity Management in Qatar
Ahmad Essa Al- Muraikhi, Mohamed Ghaith AL-Kuwari
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Early
Performance of Imaging Studies After First Urinary
Tract Infection
Khaled M. Amro, Mohamed Alnaji, Salem
Al-Zawahri, Mustafa Al-Zboon, Mohamed I. Aladwan |
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Medicine
and Society
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Supporting
Services and Quality of Life in People with Multiple
Sclerosis
Mojtaba Azimian, Mostafa Eghlima, Ghoncheh Raheb,
Mitra Zohmand, Asghar Dadkhah |
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HPV
Vaccine Hype The Gardasil; The Approved First
World Cervical Vaccine
Dr. Ebtisam |
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Clinical
Research and Methods
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How
to visualize public health data? Part one: Box
plot and map
Dr. Mohsen Rezaeian |
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| Office
Based Family Medicine |
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Otological
Manifestations among Patients with Cleft Palate
Aser El-Hrout, Khaled Hamasha, Hussien Al-Qasim |
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Chief
Editor -
Abdulrazak
Abyad
MD, MPH, MBA, AGSF, AFCHSE
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| December
2008
- Volume 6, Issue 10 |
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Otological Manifestations
among Patients with Cleft Palate
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Aser El-Hrout , MD*, Khaled Hamasha, MD*, Hussien
Al-Qasim**
* : Otolaryngeologist
** : Audiologist
Correspondence:
Dr.Khaled Hamasha
P.O.Box 150029,
Area code 13115,
ZERKA, JORDAN
Email : khamasha73@yahoo.com
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ABSTRACT
The worldwide incidence
of cleft palate (with or without cleft
lip) is 1:750- 1:2000. Patients with cleft
palate are more prone to hearing loss
than normal individuals and this decrease
in hearing is secondary to eutachian tube
(ET) dysfunction. The dysfunction in ET
function is due to an abnormal insertion
of levator veli palatini and tensor veli
palatini muscles into the posterior margin
of the hard palate and the palatal aponeurosis.
Key Words:
cleft palate,ET dysfunction, otitis media
with effusion (OME).
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This study aims to :
1- Confirm the existence of otological problems
associated with cleft palate.
2- To assess the severity of these problems
The cases are selected from patients attending
the ENT clinic at KHMC (KING HUSSEIN MEDICAL
CENTER) during the period between April 2006
- May 2007.
During the first visit, history and clinical
examination of the head and neck region are
undertaken followed by common and special investigations
done during the next visit.
Hearing assessment was performed on patients
5 years of age and above using the tuning fork
tests in the clinic and pure tone audiometry
(PTA)
Patients younger than 5 years of age hadtheir
hearing assessed by distraction tests.
Investigations :
1- PTA (patients > 5 years of age)
2- Tympanometry (to all patients in order to
assess ET function)
3- X-ray mastoids (both sides)
56 cases of cleft palate patients (with or
without cleft lip) are included in this study.
(18 patients were males and 38 were females).
20 patients belong to the age group 2-5 years
(90% are females)
8 patients belong to the 1-2 year and 5-10 year
age groups respectively.
8 infants were included in the study.
12 patients belong to the 10-20 year age group.
8 patients were older than 20 years.
About 87.5% of these patients with cleft palate
are having ear problems.
12.5% of the ears affected have normal tympanic
membrane (TM) (14 ears).
64.2% of the ears affected have dull TM with
abscent normal TM landmarks (72 ears).
7.1% of the affected ears have active effusion
with minimal retraction (8 ears).
14.2% of the ears affected have chronic suppurative
otitis media with TM perforation. (16 ears).
1.85% of the ears affected have attic pathology
and possible cholesteatoma (2 ears).
ET dysfunction was found among 84% of patients
with cleft palate and that dysfunction is inversely
related to the patient's age.
Regarding tympanometry :
23.2% of patients have Type A tympanogram.
75% of the patients have Type B tympanogram
(recurrent effusion in the middle ear) which
leads to mild to moderate conductive hearing
loss.
Only 1 patient got Type C tympanogram with ET
dysfunction (-ve middle ear pressure)
| Table
1 The
patients distribution according to otoscopic
findings the number of ear s= 112) |
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Otoscopic findings |
Number of ears |
Percentage (%) |
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Normal TM |
14 |
12.5 |
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Dull TM |
72 |
64.4 |
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Retraction/OME |
8 |
7.1 |
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CSOM with TM perforation |
16 |
14.2 |
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CSOM with attic disease |
2 |
1.8 |
| Table
2 The patients distribution according
to PTA(Pure Tone Audiometry) results(n=56) |
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Pure Tone Audiometry |
Number of Patients |
Percentage (%) |
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Normal hearing |
13 |
23.5 |
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Unilateral hearing loss |
20 |
35.3 |
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Bilateral hearing loss |
23 |
41.2 |
| Figure
1 A. Retraction
pars - tense region, B. Dull TM with loss
of light reflex - OME |
1- The most affected age group among patients
with cleft palate is 2-5 years.
2- ET dysfunction is common among these patients.
3- Most of these patients with cleft palates
and ET dysfunction suffer from hearing loss.
4- Adenoid size has no impact on the severity
of hearing loss among patients with cleft palate.
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